Clinical Comparative Study Of Risk Assessment Models For VTE In Patients With Gynecological Malignancies

BACKGROUNDVenous thromboembolism(VTE)usually occurs in tumor patients,and 20-30% of VTE is related to tumors.Gynecology is the department with high incidence of VTE.VTE can cause lower limb dysfunction in patients,and even lead to fatal events such as thrombotic syndrome and pulmonary thromboembolism due to thrombus detachment,which is one of the main causes of death.However,VTE is not only preventable,but the implementation of preventive measures will bring high social and economic benefits.OBJECTIVES(1)To evaluate the applicability of VTE routine screening model in patients with gynecological malignancies,and select a relatively good model.(2)To evaluate the ability of the Caprini and Rogers risk assessment model to screen for VTE in patients with gynecological malignancies alone.(3)To construct the joint prediction model of Caprini and Rogers,and evaluate its effect.METHODOLOGYIn this study,a case-control study was used.The VTE group selected 128 patients with VTE after surgery for gynecological malignancies,which were admitted to the Affiliated Hospital of Qingdao University from January 2016 to December 2020.According to the ratio of 1:1,128 patients with gynecological malignancies who were admitted to the hospital during the same period but did not develop VTE after surgery were randomly selected as the control group.Relevant data were mainly from the hospital medical record system.General descriptive research methods were used to describe the basic conditions of patients,t/F test was used for univariate analysis,and logistic regression was used for multivariate analysis.By drawing the ROC curve,the screening ability of the risk assessment model was evaluated.The comprehensive discrimination improvement index was adopted to evaluate the advantages and disadvantages of new and old models.MAIN RESULTS(1)In the Caprini risk assessment model,VTE family history(OR=56.599),VTE disease history(OR=49.600),major open surgery(OR=23.150),central venous access(OR=7.411),severe lung disease(OR=6.600),varicose veins(OR=5.238)and BMI(OR=3.947)were associated with the occurrence of VTE in gynecological cancer.(2)In the Rogers risk assessment model,mechanical ventilation(OR=35.234),ASA grade(B=2.785),albumin level(OR=14.687)and preoperative HCT(OR=4.745)were associated with the occurrence of VTE in gynecological cancer.(3)When the Caprini risk assessment model is used to screen for VTE alone,the critical value should be set at 9,and the grading criteria should be divided as follows: ≤ 7 points for low risk,8 points for intermediate risk,9 points for high risk,≥ 10 points for very high risk.In the low-risk group,intermediate-risk group,high-risk group and very high-risk group,the incidence of VTE was 0.00%,27.13%,74.58% and 89.09% respectively.The sensitivity and specificity were 0.727 and 0.836 respectively,the Youden index was 0.563,the positive and negative predictive values were 0.816 and 0.754 respectively,and the area under the ROC curve was 0.801.(4)When the Rogers risk assessment model is used to screen for VTE alone,the threshold value should be set as 10.The classification criteria are as follows: total score>11points is extremely high risk,9-11 points is high risk,6-8 points is medium risk,and<6 points is low risk.The incidence of VTE was 0.00%,12.90%,59.66% and 93.75% in low risk group,medium risk group,high risk group and extremely high risk group respectively,with good discrimination.At this time,the sensitivity and specificity are 0.695 and 0.828 respectively,the Yoden index is 0.523,the positive predictive value and negative predictive value are 0.802 and 0.731 respectively,and the area under the ROC curve is 0.804.(5)For the joint prediction model of Caprini and Rogers,the area under the ROC curve is 0.873.The sensitivity and specificity is 0.844 and 0.859 respectively,the Youden index is0.703,and the positive and negative predictive values are 0.857 and 0.846 respectively.CONCLUSIONS(1)The original Caprini and Rogers models are not suitable for screening VTE in gynecological malignant tumor patients,and their critical values and grading standards need to be adjusted.The corrected Caprini and Rogers models showed significant missed diagnosis when screening for VTE in patients with gynecological malignancies.(2)Through retrospective analysis,this study found that the combined screening model is superior to the Caprini and Rogers models,but its clinical value and benefits still need to be verified by a large prospective cohort study.(3)When evaluating the risk of VTE in gynecological malignant tumor patients,medical institutions should simultaneously collect relevant data on the patient’s Caprini and Rogers models.At the same time,combined with the relevant data of Caprini and Rogers models,a joint screening model should be used to evaluate the risk of VTE.