Combined D-dimer And Hypersensitive C-Reactive Protein For Early Diagnosis Of Perioperative Lung Cancer With Venous Thrombosis

Objective: To explore the diagnostic value of combined detection of hypersensitive C-reactive protein(hs-CRP)and D-dimer(DD)in perioperative venous thromboembolism(VTE)in primary lung cancer,and to effectively screen high-risk patients,Provide a strong objective basis for early diagnosis for timely intervention and treatment.Methods: A total of 120 patients who underwent surgical treatment in the Department of Thoracic and Cardiovascular Surgery of Beihai City People’s Hospital of Guangxi from January 2016 to November 2019 and were diagnosed with "primary lung cancer" by histopathology were collected.The hs-CRP and DD levels were measured before surgery and on days 1,3,5,and 7 after surgery,and the deep lower vein ultrasound Doppler examination and pulmonary CT angiography(CTA)were performed before and after the operation.The levels of hs-CRP and DD in patients with VTE and those without VTE were analyzed.Based on Logistic regression,the ROC curve was drawn to analyze the relationship between DD,hs-CRP combined measurement and VTE,and the area under the curve(AUC),Youden index,sensitivity,and specificity were calculated.Result: 1.VTE occurred in 14 of the 120 patients after surgery,accounting for 11.67 %(14/120),of which 14 were DVT,2 were central,and 12 were peripheral.The incidence was 11.67 %(14/120);lung cancer There were 3 cases of DVT and PTE at the same time.The PTE were all low-risk,with an incidence rate of 2.50 %(3/120).The patients with total lower extremity venous thrombosis or patients with central venous thrombosis and pulmonary embolism were given the lower cavity Intravenous filters and postoperative low molecular heparin calcium anticoagulation,oral rivaroxaban anticoagulation after reduced bleeding risk,and other DVT patients were treated with oral rivaroxaban anticoagulation and elastic socks.The review was performed 2 weeks after surgery and good recovery.2.There was no significant difference in the levels of DD(F = 0.559)and hs-CRP(F = 2.636)in the two groups of lung cancer patients before surgery(P>0.05).Compared with patients in the non-VTE group,hs-CRP level(F = 5.318)and DD levels(F=49.476、13.173、31.402、10.444)at day 1,3,5 and 7 were significantly increased,and the difference between the two groups was statistically significant(P <0.05).3.ROC curve analysis: The AUC value of DD single detection and the combined detection of hs-CRP and DD is greater than 0.7,which has diagnostic value.Among them,the AUC of DD is 0.776,and the best diagnostic cutoff value is 2.83 mg / L.The sensitivity and specificity are 79 % and 63 %,with a positive predictive value of 21.3 % and a negative predictive value of 94.5 %;the AUC(0.626)of hs-CRP is less than 0.7,and the optimal diagnostic cutoff is 116.50mg/ L.The sensitivity and specificity are 78 %.,44 %,Youden index is 0.222;the AUC and Youden index values of the two indicators are higher than the single test,the sensitivity is the largest,of which AUC is 0.786,specificity is 60 %,sensitivity is 85 %,and positive predictive value is 58.3 %,Negative predictive value is89.5 %,Youden index is 0.458.Conclusion: 1.The DD concentration of VTE complicated with primary lung cancer patients during perioperative period is significantly increased.The optimal diagnostic cutoff value for VTE after DD detection is 2.83 mg / L.Patients with lung cancer above this limit value need to pay attention to the occurrence of venous thrombosis.2.The hs-CRP concentration of VTE in patients with primary lung cancer during the perioperative period increased significantly,indicating a significant correlation with the occurrence of VTE.The optimal diagnostic cutoff value for VTE after hs-CRP detection is 116.50 mg / L,but AUC(0.626)Less than 0.7,the diagnostic value of VTE is limited,and the occurrence of VTE should not be diagnosed with an elevated level of hs-CRP.3.The combined detection of DD and hs-CRP for lung cancer patients with VTE after surgery has an AUC of 0.786,a sensitivity of 85 %,and a specificity of 60 %,which have diagnostic value.It shows that the above indicators are detected and observed dynamically,combined with the optimal diagnostic cutoffs of each indicator for clinical analysis and evaluation,and effective screening of high-risk patients,which provides a strong basis for the early diagnosis of perioperative VTE of primary lung cancer and timely intervention and treatment.