Risk Factors And Risk Assessment Of Deep Vein Thrombosis After Hemoperfusion In Patients With Acute Poisoning

Objective:This study analyzed the clinical data of patients with acute poisoning who underwent hemoperfusion to understand the occurrence of deep vein thrombosis after hemoperfusion in patients with acute poisoning,screened for the risk factors of deep vein thrombosis in patients with acute poisoning.To compare the predictive value of several commonly used deep vein thrombosis risk assessment models for deep vein thrombosis in patients with acute poisoning.To develop an individualized thrombosis risk assessment model for the patients with acute poisoning,in order to provide a basis for risk assessment and prevention of deep vein thrombosis in such patients.Methods:This study is a cross-sectional survey study.The patients with acute poisoning who were treated in a top three hospital in Shandong from October 2017 to February 2019 were selected as subjects.All patients underwent hemoperfusion through the femoral vein.Doppler ultrasound examination of lower extremity veins was performed after extubation.A total of 311 patients who met the inclusion criteria were collected and recorded general information,types of poisoning,hemoperfusion related data,information on central venous catheters,relevant laboratory indicators,and disease Clinical information on disease and medical history,and results of venous ultrasound in both lower extremities.According to the results of vein Doppler ultrasound of the lower extremities,the subjects were divided into thrombus group and non-thrombosis group.Data analysis was performed using SPSS22.0 statistical software.Descriptive statistical analysis was carried out on the adoption rate,percentage,mean and standard deviation of the general data and the current survey results.The independent sample t test,Mann-Whitney U test and chi-square test were used for comparison between groups.With or without deep vein thrombosis as the dependent variable,the factors affecting deep vein thrombosis were independent variables,and the variables were analyzed by univariate analysis to find out the risk factors of deep vein thrombosis in this type of patients.Variables with statistical significance in univariate analysis were analyzed by binary multivariate logistic regression analysis to screen for independent risk factors for deep vein thrombosis in these patients.The Caprini risk assessment model,the Autar risk assessment model,and the Padua risk assessment model were used to score the thrombus risk in patients with acute poisoning.The MedCalc software was used to compare the area under the ROC curve and sensitivity and specificity of the three thrombosis risk assessment models.Based on the results of logistic regression analysis,a high-risk prediction model for acute poisoning patients was established and its accuracy was evaluated.Results:1.The incidence of deep vein thrombosis after hemoperfusion in acute poisoning patients was 59.2%(184 cases),age(36.05±16.53)years old,including 86 males,98 females.2.Unifactorial analysis results:there were statistically significant differences in body mass index,days of femoral vein catheterization,whether to carry femoral vein catheter transport,D-dimer,homocysteine and blood lipid in deep vein thrombosis after hemoperfusion in patients with acute poisoning(p<0.05).3.The incidence of deep vein thrombosis was taken as the dependent variable,and body mass index,days of femoral vein catheterization,whether to carry femoral vein catheter transport,D-dimer,serum homocysteine and abnormal blood lipid were taken as independent variables for binary multivariate logistic regression analysis.The results showed that days of femoral vein catheterization,transshipment with the femoral vein,elevated serum homocysteine,and dyslipidemia were the main predictors of deep vein thrombosis after acute perfusion in patients with acute poisoning.4.The Caprini risk assessment model,Autar risk assessment model,and Padua risk assessment model were used to assess the risk of thrombosis in patients with acute poisoning,the scores were(7.55±1.76),(8.63±2.36),and(3.92±0.55).The Caprini risk assessment model was significantly different(p<0.05)in the high-risk patients in the thrombus group and the non-thrombotic group,and the difference between the other two models was not significant(p>0.05).The area under the ROC curve of the Caprini risk assessment model,the Autar risk assessment model,and the Padua risk assessment model were 0.673,0.585,and 0.535,respectively.The difference of the area under the ROC curve between the Caprini risk assessment model and the Autar risk assessment model as well as the Padua risk assessment model was significant(p<0.05),but the area under the ROC curve of the Autar risk assessment model and the Padua risk assessment model was not statistically significant(p>0.05).The Caprini risk assessment model has a sensitivity of 91.9%,a specificity of 33.1%,and the Yoden index was 0.249.The sensitivity of the Autar s risk assessment model was 37.0%,specificity was 77.2%,and the Yoden index was 0.141.The Padua risk assessment model has a sensitivity of 91.3%,a specificity of 15.0%,and the Yoden index was 0.063.5.The prediction model established in this study has an area under the ROC curve of 0.713,the optimal threshold was 58.9,the sensitivity was 39.7%,the specificity was 92.1%,and the Yoden index was 0.318.Conclusion:1.In this study,the incidence of deep vein thrombosis after hemoperfusion in patients with acute poisoning was high,and most of them were hidden asymptomatic deep vein thrombosis,which should attract the attention of relevant medical personnel and strengthen risk assessment and prevention.2.The main risk factors for deep vein thrombosis after hemoperfusion in patients with acute poisoning included days of femoral vein catheterization,transshipment with the femoral vein,elevated serum homocysteine and dyslipidemia.In practice,try to avoid or reduce the impact of these factors on deep vein thrombosis,and take appropriate physical prevention and drug prevention measures.3.The predictive model established in this study has higher prediction accuracy for deep vein thrombosis in acute poisoning patients than the Autar risk assessment model and the Padua risk assessment model,but the difference was not obvious compared with the Caprini risk assessment model.In practice,this predictive model can be combined with the Caprini risk assessment model to comprehensively assess the risk of deep vein thrombosis in patients with acute poisoning and to implement appropriate preventive measures.