中华护理杂志 ›› 2023, Vol. 58 ›› Issue (19): 2333-2338.DOI: 10.3761/j.issn.0254-1769.2023.019.004

• 老年护理专题 • 上一篇    下一篇

老年肺癌患者静脉血栓栓塞症风险预测工具的比较研究

梅茵(), 黄立学, 刘晔, 陈伟()   

  1. 100730 北京市 北京医院呼吸与危重症医学科/国家老年医学中心/中国医学科学院老年医学研究院(梅茵,黄立学,陈伟);国家卫生健康委北京老年医学研究所/国家卫生健康委老年医学重点实验室(刘晔)
  • 收稿日期:2023-04-03 出版日期:2023-10-10 发布日期:2023-10-12
  • 通讯作者: 陈伟,E-mail:18612989622@163.com
  • 作者简介:梅茵:女,本科,主管护师,护士长,E-mail:meiyin3449@bjhmoh.cn
  • 基金资助:
    2020-2021年院级科研课题项目(BJ-2019-171)

A comparative study of risk prediction models for venous thromboembolism in elderly patients with lung cancer

MEI Yin(), HUANG Lixue, LIU Ye, CHEN Wei()   

  • Received:2023-04-03 Online:2023-10-10 Published:2023-10-12

摘要:

目的 比较4种静脉血栓栓塞症(venous thromboembolism,VTE)风险评估工具对老年肺癌患者发生VTE的预测效能。方法 连续选择2020年1月—2022年6月,北京市某三级甲等医院呼吸与危重症医学科住院的老年肺癌患者,采用Caprini评分、Padua评分、Khorana评分和COMPASS-CAT评分4种风险评估工具进行血栓风险评估,并随访至入组后第6个月。根据各评分对应截断值将患者分为低中危组和高危组,比较两组之间发生VTE的差异。利用受试者工作特征曲线下面积评价4种VTE预测工具对老年肺癌患者远期发生VTE的预测效能。结果 纳入111例老年肺癌患者,入组后6个月内,20例(18.0%)发生VTE。VTE组和未发生VTE组D-二聚体的比较,差异有统计学意义(P<0.05)。Caprini评分高危组VTE发生率显著高于中危组,差异有统计学意义(P=0.022),Padua评分高危组VTE发生率显著高于低危组,差异有统计学意义(P<0.001),而Khorana和COMPASS-CAT评分高危组VTE发生率均高于非高危组,但差异无统计学意义(均P>0.05)。Padua评分、Caprini评分、Khorana评分和COMPASS-CAT评分对应的受试者工作特征曲线下面积依次为0.805(95%CI:0.672~0.937)、0.757(95%CI:0.643~0.871)、0.552(95%CI:0.401~0.704)和0.515(95%CI:0.356~0.673)。结论 老年肺癌患者VTE发生率高,亟须通过风险预测工具早期发现高危人群。Padua评分系统对老年肺癌患者VTE风险的预测效能优于Caprini评分、Khorana评分和COMPASS-CAT评分。

关键词: 老年人, 肺癌, 静脉血栓栓塞症, 风险评估, 护理

Abstract:

Objective To compare the predictive performance of 4 risk assessment models for venous thromboembolism(VTE) in elderly patients with lung cancer. Methods We prospectively and consecutively recruited lung cancer patients aged ≥60 years who were admitted to the Department of Respiratory and Critical Care Medicine of Beijing Hospital between January 2020 and June 2022,and followed up them for VTE within 6 months after enrollment. Caprini score,Padua score,Khorana score and COMPASS-CAT score were used to evaluate the risk of VTE of each patient,and then they were divided into a low-medium risk group or a high-risk group based on the cut-off value of each score. We compared the rates of VTE in the follow-up period between both groups. The area under receiver operative characteristic(AUC) was used to evaluate the predictive performance of the 4 models for long-term VTE in elderly patients with lung cancer. Results A total of 111 elderly patients with lung cancer were enrolled. The mean(±SD) age was(70.9±7.1) years;31(27.9%) were women;92(82.9%) were patients with non-small cell lung cancer. 20(18.0%)patients developed VTE within 6 months after enrollment. There were no significant differences in age,gender,BMI and comorbidity between the VTE group and the non-VTE group. The incidence of VTE in high-risk group assessed by Caprini score was significantly higher than that in medium-risk group. The incidence of VTE in high-risk group assessed by Padua score was significantly higher than that in low-risk group. However,the incidences of VTE in high-risk group assessed by Khorana and COMPASS-CAT scores were numerically higher than that in the corresponding comparative group(all P>0.05). The AUC for VTE in Padua score,Caprini score,Khorana score and COMPASS-CAT score were 0.805(95% CI:0.672~0.937),0.757(95% CI:0.643~0.871),0.552(95%CI:0.401~0.704),and 0.515(95%CI:0.356~0.673),respectively. Conclusion Elderly patients with lung cancer had a high incidence of long-term VTE,and a risk predictive model is urgently needed to identify high-risk patients. Compared with Caprini score,Khorana score,and COMPASS-CAT score,Padua score showed a better ability in predicting the risk of VTE among elderly patients with lung cancer.

Key words: Aged, Lung Cancer, Venous Thromboembolism, Risk Assessment, Nursing Care