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

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