Risk Assessment Of Venous Thromboembolism In Hospitalized Respiratory Patients And Intervention Status Survey

Objective:1.The Caprini scale and Padua scale were used to assess the risk of VTE occurrence in hospitalized patients in the respiratory department,so as to understand the proportion and risk distribution of high-risk groups of VTE in the respiratory department.2.Investigate the bleeding risk and prevention of VTE in high-risk groups.3.Compare the practicability of Caprini scale and Padua in predicting VTE in hospitalized patients in respiratory department.Methods:Use retrospective analysis to conduct research.Relevant data were collected continuously from March 1,2019 to May 31,2019,inpatients in the Department of Respiratory and Critical Care Medicine,First Hospital of Shanxi Medical University,and a total of 683 patients were finally included according to the admission criteria.The inpatients were evaluated using the Padua score and Caprini score models,and the risk of bleeding was evaluated for high-risk patients.The prevention of high-risk patients with VTE was investigated,and descriptive analysis of the research data was performed.Calculate the area under the ROC curve under the Caprini score model and the Padua score model,and compare the ability of the two models to predict the occurrence of VTE in inpatients in the respiratory department.Results:1.The 683 patients in the survey were aged from 19 to 93 years,with an average of62.46 ± 17.13 years.There were 433 males(63.4%)and 250 females(36.6%).The average hospitalization date(including RICU hospitalized patients)was 12.62 ± 4.27 days.The average hospitalization cost was 16366.22 ± 4340.46 yuan.Respiratory disease distribution is classified by main diagnosis: 171 cases of malignant tumors(25.04%),infectious diseases of the lungs(including bacterial pneumonia,viral pneumonia,fungal pneumonia,mycoplasma pneumonia,chlamydia pneumonia,pulmonary aspergillosis and other pathogens 159 cases(23.28%)of lung infections,78 cases of chronic pulmonary heart disease(11.42%),75 cases of chronic obstructive pulmonary disease(10.98%),47 cases of bronchial asthma(6.88%),interstitial 52 cases of pulmonary disease(7.61%),36 cases of tuberculosis and suspected cases(5.27%),17 patients diagnosed with VTE during admission(2.49%),16 cases of bronchiectasis with infection(2.34%),5 cases of spontaneous pneumothorax(0.73%),4 cases(0.59%)of airway stenosis and foreign body,23 cases(3.37%)with unclear diagnosis and other cases.The overall incidence of VTE in inpatients in the respiratory department was2.49%.2.321 patients(47.0%)at high risk of VTE under the Padua score model were included;368 patients(53.88%)were at high risk under the Caprini score model.Using McNemar's X2 test,X2 = 29.45,P <0.001,the difference between the two assessments was statistically significant.3.The most common risk factors for the Caprini scoring model in assessing the risk of hospitalized patients are severe lung disease(73.5%),pulmonary dysfunction(44.80%),and malignant tumors(25.03%).The Padua scoring model is the most common in evaluating inpatients.The risk factors were acute infection and / or rheumatic disease(69.99%),heart and / or respiratory failure(60.46%),and age over 70(27.23%).4.Of the 368 high-risk patients under the Caprini score,62(16.85%)had a higherrisk of bleeding,and 57 of the 321 high-risk patients under the Padua score(17.76%)had a higher risk of bleeding.5.During the hospitalization period,only 24 patients received VTE preventive measures,of which 22 were drug prevention,2 were physical prevention,and patients without drug combined with physical prevention.Caprini scored 21 patients at high risk to take preventive measures,accounting for 5.7% of the high-risk group;Padua scored 22 patients at high risk,accounting for 6.85%.6.There were 17 patients diagnosed with VTE during hospitalization.The Padua score and Caprini score of VTE patients were higher than those of non-VTE patients,and the difference was statistically significant(P <0.001).The areas under the ROC curves of the Caprini and Padua risk assessment models were 0.62 and 0.56,respectively.The sensitivity of the two models to VTE prediction was 94.12%,88.23%,and the specificities were 31.53%,54.05%,respectively.The area under the two curves was compared P <0.001,and the difference was statistically significant.conclusion:1.VTE risk is higher in hospitalized patients in respiratory medicine,and the high-risk population mainly occurs in patients with advanced lung disease,severe pulmonary disease,respiratory or heart failure,and lung cancer.2.The proportion of VTE patients at high risk in respiratory medicine to take preventive measures is not optimistic,and preventive measures need to be improved;patients with a high risk of bleeding account for a certain proportion,and anticoagulant treatment and other measures should be implemented with caution.3.Both the Caprini risk assessment model and the Padua score model can be applied to VTE risk assessment of inpatients in respiratory medicine.The Padua score model is relatively simple and easy to implement,and the Caprini model has relativelyhigh predictive power.