| Objective:To investigate the occurrence of lower extremity venous thrombosis and the risk factors of thrombosis in patients with acute carbon monoxide poisoning,and to provide clinical evidence for the prevention and control of lower extremity venous thrombosis in patients with acute carbon monoxide poisoning.Methods:The clinical data of all patients with acute carbon monoxide poisoning who were hospitalized in the emergency department of the Affiliated Hospital of Jining Medical College in Shandong Province from October 2018 to February 2022 were collected.According to the results of lower extremity venous ultrasonography within 48 hours of admission,the patients were divided into a thrombosis group and a non-thrombotic group.All data were statistically analyzed using SPSS 19.0 software and R software.The basic data and related biochemical indicators were compared between the two groups,and the univariate analysis of thrombosis was performed,and then the variables with statistical significance in the univariate analysis were included in the logistic regression multivariate analysis to obtain independent risk factors.The receiver operating characteristic curve(ROC)was drawn from the independent risk factors to calculate the cutoff value of each independent risk factor,as well as the sensitivity and specificity corresponding to the cutoff value,and the cutoff value corresponding to the maximum value of Youden index was the most best cutoff value.ROC curve comparison using Delong test.P < 0.05 was considered statistically significant.Results:1.A total of 703 cases of patients with acute carbon monoxide poisoning were collected.According to the ultrasound examination results of lower extremity venous blood vessels within 48 hours of admission,158 patients with lower extremity venous thrombosis were screened,and 240 patients did not have lower extremity venous thrombosis.The incidence of lower extremity venous thrombosis was 22.48%.Finally,according to the inclusion and exclusion criteria,a total of 145 cases in the thrombosis group and 212 cases in the non-thrombotic group were included for statistical analysis.2.Among the 158 patients with lower extremity venous thrombosis,there were 139 cases of intermuscular venous thrombosis and 19 cases of other deep vein thrombosis,mainly popliteal vein,peroneal vein,and posterior tibial vein.The lower extremity venous thrombosis in patients with acute carbon monoxide poisoning was almost always isolated distal deep venous thrombosis.3.The comparison results between the two groups showed: There were significant differences in age,coma time,lymphocyte count,platelet count,procalcitonin,C-reactive protein,D-dimer,alanine aminotransferase,plasma albumin,serum creatinine,blood urea nitrogen,myoglobin,creatine kinase,creatine kinase isoenzyme,lactate dehydrogenase,hydroxybutyrate dehydrogenase(P<0.05);There were no significant differences in gender,body mass index,hypertension,coronary heart disease,diabetes,smoking history,drinking history and other test indicators(P>0.05).4.The results of univariate analysis showed: There were significant differences in age,coma time,start time of hyperbaric oxygen therapy,C-reactive protein,procalcitonin,D-dimer,plasma albumin,serum creatinine,blood urea nitrogen,myoglobin,creatine kinase,creatine kinase isoenzyme,lactate dehydrogenase and hydroxybutyrate dehydrogenase(P<0.05).5.All variables that were meaningful in univariate analysis were included in the multivariate logistic regression model for analysis,and after adjustment,we obtained age(OR 1.028,95% CI 1.007 to 1.051),duration of coma(OR 1.028,95% CI 1.001 to1.055),C-reactive protein(OR 1.017,95% CI 1.003 to 1.031),procalcitonin(OR 1.241,95% CI 1.063 to 1.532),D-dimer(OR 1.162,95% CI 1.049 to 1.286);They are the independent risk factors for lower extremity venous thrombosis in patients with acute carbon monoxide poisoning.6.Receiver operating characteristic(ROC)analysis was performed for each independent risk factor.The area under the curve of age was 0.608.When the age was68.5 years old,the Youden index was the largest,and the inspiration and specificity were66.9% and 52.8%,respectively;The area under the curve of the coma time was 0.648.When the coma time was 2.5h,the Youden index was the largest,and the inspiration and specificity were 63.4% and 61.8%,respectively;The area under the curve of C-reactive protein was 0.639,and when the cut-off value was 26.63 mg/L,the Youden index was the largest,and the sensitivity and specificity were 30.2% and 89.5%,respectively;The area under the curve of procalcitonin was 0.606.When the cut-off value was 0.581ng/m L,the Youden index was the largest,and the inspiration and specificity were 35.2% and 82.5%,respectively;The area under the curve of D-dimer was 0.750,the cut-off value was 1.185mg/L,the Youden index was the largest,and the sensitivity and specificity were 62.1%and 79.7%,respectively.The combined monitoring of C-reactive protein,procalcitonin and D-dimer showed that the area under the curve was 0.740,the sensitivity and specificity were 73.1% and 68.3%,respectively.Which was more valuable in predicting thrombus than C-reactive protein and procalcitonin alone.Conclusion:1.Patients with acute carbon monoxide poisoning have a high incidence of thrombosis within 48 hours of admission,which is 22.48%,which is much higher than that of the general population.It is necessary to strengthen the prevention and control of thrombosis in such patients.2.The lower extremity venous thrombosis in patients with acute carbon monoxide poisoning is almost always isolated distal deep vein thrombosis.3.Coma time,C-reactive protein,procalcitonin,and age are independent risk factors for lower extremity venous thrombosis in patients with acute carbon monoxide poisoning.D-dimer is still a sensitive indicator for predicting thrombosis.The combined monitoring of C-reactive protein,procalcitonin and D-dimer has higher predictive value for thrombus than C-reactive protein and procalcitonin alone. |
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