| Objective: To investigate the risk factors of venous thromboembolism(VTE)in patients with neurosurgical brain tumors;Improve the Caprini Risk Assessment Model(Caprini RAM)for patients with neurosurgical brain tumors and redefine risk stratification;Improve the predictive value of VTE occurrence in patients with neurosurgical brain tumors,accurately screen high-risk patients with neurosurgical brain tumors,provide evidence for VTE prevention and treatment in future brain tumor patients,reduce the occurrence of VTE,and prevent excessive prevention.Methods:(1)Preliminary construction of a VTE risk factor library for neurosurgical brain tumor patients through literature research;(2)An expert meeting was held to invite 11 experts to discuss the VTE risk factors database of neurosurgical brain tumor patients,screen risk factors,and form the final version of the neurosurgical brain tumor patient data collection table;(3)The case-control study method was used to collect the clinical data of brain tumor patients admitted to the First Affiliated Hospital of Xinjiang Medical University and the People’s Hospital of neurosurgery of Xinjiang Uygur Autonomous Region from January 2017 to December 2021.The ratio of the case group to the control group was 1:1.Neurosurgery brain tumor patients diagnosed with VTE were taken as the case group,and neurosurgery brain tumor patients without VTE were randomly selected as the control group.The collected data of 660 patients were randomly divided into a modeling group and a validation group based on a 7:3 ratio.The factors with statistical significance in the single factor analysis in the modeling group were included in the multi factor analysis to explore the independent risk factors of VTE in neurosurgery brain tumor patients.According to the regression coefficient(b value),the new risk factors were assigned values,and the risk stratification of the modified Caprini RAM was performed by rapid cluster analysis.In the validation group,the chi-square test was used to compare the hierarchical effectiveness of the original version of Caprini RAM and the modified version of Caprini RAM.The receiver operating characteristic curve(ROC)curve was used to compare the area under the curve,sensitivity,and specificity of the two models.Results:(1)Through literature research,combined with the original risk factors of Caprini RAM,a VTE risk factor library for neurosurgical brain tumor patients was formed,including 82 risk factors;(2)The effective recovery rate of the expert meeting form is 100%,and the expert authority coefficient is 0.92.Based on expert opinions,32 risk factors were deleted,2 risk factors were changed,6 risk factors were added,and 54 risk factors were finally included in the VTE risk factor database of neurosurgery patients with brain tumor;(3)A total of 660 neurosurgical brain tumor patients and 330 VTE patients were included in this study,including 34 patients with symptomatic deep venous thrombosis(DVT),mainly characterized by swelling,and 6 patients with symptomatic pulmonary thromboembolism(PTE),mainly characterized by chest tightness and chest pain;(4)Univariate analysis of modeling samples showed that the VTE and non VTE groups had significant differences in age,tumor type,severe pulmonary disease,stroke,bed rest time>72 hours,other congenital or acquired thrombosis,lower limb edema,surgical duration,planned minor surgery,open major surgery,intraoperative blood transfusion,central venous access,use of glucocorticoids,use of dehydrating agents,use of hemostatic drugs,use of chemotherapy drugs,increased D-dimer for the first time after surgery There was a statistically significant difference in the first postoperative prothrombin time reduction and the first postoperative fibrinogen increase(P<0.05);Multivariate logistic regression analysis showed that age,tumor type,severe lung disease,bed rest time>72h,other congenital or acquired thrombosis,operation duration>322.5min,intraoperative blood transfusion and first postoperative fibrinogen increase were independent risk factors for VTE in neurosurgery patients with brain tumor(P<0.05);(5)Modified Caprini risk assessment model including 42 risk factors.After cluster analysis,the model’s risk was stratified into low risk(0～5),medium risk(6～10),high risk(11～16),and extremely high risk(≥17);(6)Using validation samples,a comparison of the effectiveness of risk stratification between the original Caprini risk assessment model and the modified Caprini risk assessment model showed that the differences between the two groups were statistically significant(P<0.05);(7)The ROC curve analysis results show that the Area Under Curve(AUC)of the original Caprini RAM is 0.734,with a 95% confidence interval of 0.666～0.803,a cutoff value of 5.5,a Jordan index of 0.347,a sensitivity of 85.7%,and a specificity of 49.0%;The AUC of the improved Caprini RAM is 0.851,with a 95%confidence interval of 0.798～0.903,a cutoff value of 8.5,a Jordan index of 0.588,a sensitivity of 88.8%,and a specificity of 70.0%.Conclusions:(1)The enthusiasm and authority of the experts in this research expert meeting can be accepted,and the results of the expert meeting are reliable;(2)Age,tumor type,severe lung disease,bed rest time>72h,other congenital or acquired thrombosis,operation duration>322.5min,intraoperative blood transfusion and first postoperative fibrinogen increase are independent risk factors for VTE in neurosurgery patients with brain tumor;(3)The modified Caprini risk assessment model includes 42 risk factors,which are divided into four risk stratification: low risk(0～5),medium risk(6～10),high risk(11～16),and extremely high risk(≥17);(4)Both the original Caprini RAM and the modified Caprini RAM have moderate predictive value for the risk of VTE in neurosurgery brain tumor patients,but the modified Caprini RAM has increased specific risk factors according to the disease characteristics of brain tumor,which has better predictive effect. |
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