Predictive Value Of Logistic Regression Combined With ROC Curve In The Evaluation For Venous Thromboembolism By D-Dimer After Urological Surgery

Objective: To investigate the risk factors after urological surgery,the significance of dynamic monitoring of D-Dimer on prevention and treatment for postoperative VTE after urological surgery.Methods: From 2015-07~2018-01,212 cases who underwent urological surgery(excluding urinary stones surgery)were analyzed.The clinical data were collected: gender,age,body mass index,history of hypertension,history of diabetes,history of thrombosis,disease type,anesthetic type,opeative type,opeative time,hemostatic drugs introperation(HDI),hemostatic drugs postoperation(HDP),preoperative DDimer(PD),D-Dimer of postoperative day 1(DOPD1),D-Dimer of postoperative day 3(DOPD3),D-Dimer of postoperative day 5(DOPD5),RBC,HB,PLT,PT,APTT,ALT,Cr.All cases are divided into two groups and converted D-D data into ordered classifying and counting data.The univariate analysis of the suspicious risk factors as independent variables,logistic analysis independent risk factors for postoperative VTE.Draw out receiver operatingcharacteristic curve(ROC)to determine the diagnostic efficacy of each indicator and reveal the diagnostic value of each factor.Results: Univariate analysis showed that there was significant difference between the two groups in opeative type,opeative time,HDI,DOPD1,DOPD3 and DOPD5,P <0.05.Further logistic analysis showed that DOPD1,DOPD3 and DOPD5 were independent risk factors for VTE after urological surgery,P <0.05.The corresponding OR values were 19.898,19.300,9.159 respectively.ROC analysis showed that diagnostic threshold of DOPD1,DOPD3,DOPD5 were >1;the maximum area under the curve(AUC)were 0.878,0.745,0.687,the corresponding Youden index,sensitivity and specificity of DOPD1,DOPD3 and DOPD5 were 0.682,0.420,0.350,70.59%,43.33%,39.29%;97.66%,98.72%,95.70% respectively.Conclusion: 1.It's valuable of monitoring dynamically postoperative D-D for early prediction and diagnosis of VTE in urological surgery and it can help clinicians to intervene and avoid more serious conditions.Especially for the first 5 days after surgery(very early,early,mid-term),it is very important.If possible,it's better of monitoring patients till they can get up and move around.2.D-D rising is an independent risk factor for VTE in urologic surgery.For each level of DOPD1 increasing,the possibility of VTE increases 19.898 times;for each level of DOPD3 increasing,the possibility of VTE increases 19.300 times;for each level of DOPD5 increasing,the possibility of VTE increases 9.159 times.3.DOPD1,DOPD3 and DOPD5 have moderate,moderate and low diagnostic value for VTE in urological surgery respectively.4.Consider the diagnosis of VTE when DOPD1,DOPD3,and DOPD5?5ug/ml but however,it is still recommended to dynamic monitor D-D in combination with the Caprini assessment scale and(or)Wells assessment scale.