| Background and objective:Patients with cancer are 9 times more likely to develop venous thromboembolism（VTE）than the general population.Cancer patients with deep vein thrombosis（DVT）usually have low survival rates and poor prognosis,and in severe cases can lead to fatal pulmonary embolism（PE）.Over 50% of DVT events are asymptomatic DVT and only 20% of patients with DVT-related symptoms are ultimately diagnosed with DVT after imaging.Therefore,early screening and diagnosis of DVT in cancer patients are particularly important.The Wells score and modified Wells score are widely used to assess patients’ risk of DVT and to guide clinical decision-making,but it is unclear whether they can apply to Chinese cancer patients.This study used a prospective study to assess the predictive value of the Wells score and modified Wells score plus D-dimer in cancer patients with DVT,to provide additional basis for DVT risk assessment and clinical decision making in cancer patients.Methods:Lower extremity ultrasound stud（LEUS）and D-dimer testing were performed on all adult hospitalized patients with cancer attending the Jilin University First Hospital Oncology Center between May 3,2017,and August 9,2021.The risk of DVT was stratified using the Wells score,modified Wells score and plus D-dimer as risk assessment tools respectively.The sensitivity,specificity,negative predictive value,negative likelihood ratio,rate of missed diagnosis rate and failure rate were calculated to compare the predictive value of each model.Results:A total of 2017 patients were included in this study,the main results are as follows:1.Overall,275（13.6%）cancer patients were observed to have DVT.In this study,age and the presence of major surgery within 4 weeks differed between the DVT and non-DVT groups（all P< 0.05）.Symptoms of DVT are not specific,with 5.6% of patients in the non-DVT group having symptoms such as lower extremity swelling,while only 4% of patients in the DVT group have clinical symptoms.2.In this study,the sensitivity,specificity,missed diagnosis rate and failure rate of Wells score ≤1 were 67%,24%,33.1% and 17.9%,respectively.An exclusion diagnosis based on the modified Wells score ≤1had a sensitivity of 59%,a specificity of 57%,a missed diagnosis rate of41.1%,and a failure rate of 10.2%.The sensitivity and specificity of the Wells score and modified Wells score did not reach the predicted value of previous studies,and the failure rate and missed diagnosis rate were high.3.In this study,the predictive value of the Wells score and the modified Wells score was improved with the combination of D-dimer.If the exclusion diagnosis was made based on the Wells score ≤1 combined with a negative D-dimer,the sensitivity can be increased to 86%,but the specificity was not improved;the missed diagnoses rate and failure rate decreased to 14.2% and 5.1%,respectively.If the diagnosis is excluded based on the modified Wells score ≤1 and a negative D-dimer,the sensitivity can be increased to 92%,and the missed diagnosis rate and failure rate are reduced to 7.6% and 3.6%,respectively.The combination of D-dimer can improve the predictive value,but has not reached the expected value.The safety was improved,but it still exceeded the 2% safe threshold for failure diagnoses.Conclusions:1.The exclusion diagnosis based on Wells score ≤1 or modified Wells score indicating low risk has low sensitivity and specificity,but with high failure rate,thus DVT cannot be accurately excluded.2.After combining D-dimer,it can improve sensitivity and reduce the rate of missed diagnoses and failure rates.However,none of them achieved the predictive value of previous studies in European and American populations and non-tumor patients,and the failure rate was not reduced below the safety threshold of 2%.3.Wells scores,modified Wells scores with or without D-dimer are not available for cancer patients in our center.It is of clinical significance to actively screen all cancer patients with LEUS,which can avoid the missed diagnosis of low-risk patients. |
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