The Application Value Of Padua Scale In Venous Thromboembolism In Inpatients With Rheumatic Diseases

Objective: To investigate the status of venous thromboembolism(VTE)in inpatients in the department of rheumatology,and to explore the efficiency of Padua scale in these patients.Methods: The medical records of 2282 patients hospitalized in the Department of Rheumatology werecollected at Sichuan Provincial People’s Hospital from September2018 to December 2020.The occurrence of VTE and the correlation between Padua score and VTE events were compared between high(Padua score≥4)and low(Padua score<4)risk groups.Risk factors for VTE in rheumatology inpatients were determined by multivariate logistic regression.The value of the Padua scale and possible improved model in predicting VTE was assessed by ROC.Results:1.There were 2282 patients in our study,50(2.2%)in the VTE group and 2232(97.8%)in the non-VTE group.The top three diseases for VTE were systemic lupus erythematosus(34.0%),rheumatoid arthritis(18.0%),and systemic vasculitis(16.0%).All rheumatic diseases in the VTE group were active.2.The Padua scores of VTE group and non-VTE group were 3(2,6)points and 2(1,2)points,respectively(P<0.001),and thehigh-risk patients ratio in the two groups was 48.0%and 7.4%,respectively(P < 0.001).3.There were 189 patients(8.3%)in the high-risk group and 2093 patients(91.7%)in the low-risk group with Padua score.The incidence of VTE was 12.7% and 1.2% in the two groups,respectively(P < 0.001).4.APS,previous history of VTE,duration of bed rest>3 days,high D-D,and decreased serum albumin were all independent risk factors for VTE in rheumatology inpatients,with APS being the most closely associated with the occurrence of VTE(OR=19.446).5.The AUC of the Padua scale,the Padua combined model(Padua scale combined with D-D,serum albumin),and the independent risk factor combined prediction model were0.771,0.836,and 0.873,respectively.Among them,the AUC of the combined prediction model of independent risk factors was higher than that of the Padua scale(? =3.774,P<0.001)and the combined model of Padua(?=1.999,P=0.045).The AUC of the Padua combined model was higher than that of the Padua scale(?=4.202,P<0.001).6.Proportion of prophylactic anticoagulation therapy was 14.8% in high risk group and3.6% in low risk group(P<0.01).Conclusion:1.The incidence of VTE in hospitalized patients in the Department of Rheumatology was 2.2%.The independent risk factors associated with the occurrence of VTE were age,past history of VTE,APS,time in bed > 3 days,high D-D and decreased serum albumin,of which APS was the highest grade independent risk factor.2.Padua scale can reflect the risk of VTE events in patients with rheumatism to a certain extent,but the predictive efficacy is limited.The value of Padua combined with D-D and serum albumin in predicting VTE is better than that of Padua scale;the value of independent risk factor combined prediction model in predicting VTE is better than that of Padua scale and Padua scale combined with D-D and serum albumin,which has potential clinical application value.3.The rate of VTE prophylaxis is low in patients hospitalized in rheumatology departments.Rheumatologists should think highly of the VTE prophylaxis and treatment of high risk patients.