Padua评分联合D-二聚体对COVID-19患者发生静脉血栓栓塞症的预测价值研究  

Predictive value of Padua prediction score combined with D-dimer for VTE development in patients with COVID-19

作　　者：王少飞[1] WANG Shaofei(Department of Respiratory and Critical Care Medicine,the Affiliated Hospital of Chengde Medical College,Chengde,Hebei 067000,China)

机构地区：[1]承德医学院附属医院呼吸与危重症医学科,河北承德067000

出　　处：《临床肺科杂志》2023年第12期1831-1835,共5页Journal of Clinical Pulmonary Medicine

基　　金：中国医学科学院医学与健康科技创新工程(CIFMS)(No.2021-I2M-1-061);2018年度承德市科技计划自筹经费项目(No.201804A020)。

摘　　要：目的Padua评分联合D-二聚体在预测新型冠状病毒感染(COVID-19)患者发生静脉血栓栓塞症(VTE)中的价值。方法收集2022年12月-2023年2月于承德医学院附属医院内科住院的COVID-19患者441例,其中VTE组195例,无VTE组246例。分析两组患者基本资料,绘制Padua评分、D-二聚体以及两者联合时预测COVID-19患者发生VTE的受试者工作特征曲线(ROC曲线),并比较三种方法曲线下面积(AUC)。应用Logistic回归分析探讨Padua评分危险分层(Padua评分≥4分)和D-二聚体水平与VTE发生风险关系。结果VTE组患者Padua评分和D-二聚体均高于无VTE组。Padua评分、D-二聚体预测COVID-19发生VTE的最佳截断值分别为4.5分和1.485μg/mL,约登指数为0.446和0.484,灵敏度为0.641和0.744,特异度为0.805和0.740,AUC为0.789和0.804,两者AUC比较差异无统计学意义(Z=0.512,P=0.609);COVID-19患者,其VTE发生风险随评分(Padua评分≥4分者)的升高而增加,随D-二聚体水平升高而增加,差异均有统计学意义(P<0.05);Padua评分联合D-二聚体预测COVID-19发生VTE的最大约登指数为0.575,灵敏度和特异度分别为0.795和0.780,AUC为0.863,较单独使用Padua评分、D-二聚体的AUC均升高,且差异均有统计学意义(Z=4.655,P<0.001和Z=3.606,P<0.001)。结论Padua评分、D-二聚体水平与COVID-19患者VTE的发生风险可能存在相关,两者联合对COVID-19患者发生VTE可能有较好的预测价值。Objective To explore the predictive value of Padua prediction score combined with D-dimer in venous thromboembolism with COVID-19.Methods 441 patients with COVID-19 who were hospitalized in the Internal Department of the Affiliated Hospital of Chengde Medical University admitted from December 2022 to February 2023,including 195 cases in the VTE group and 246 cases in the non-VTE group.The basic data of the two groups were analyzed.The receiver operating characteristic curve(ROC curve)of Padua Prediction Score,D-dimer,and the combination of predicting VTE in COVID-19 patients was drawn to compare the area under the curve of the 3 methods.A Logistic regression analysis was used to investigate the risk stratification of Padua Prediction Score(≥4 points of Padua prediction score)and D-dimer level with the risk of VTE.Results Compared with the non-VTE group,the VTE group had higher Padua prediction score and D-dimer.The optimal cut-off value for Padua prediction score and D-dimer prediction of COVID-19 VTE were 4.5 points and 1.485μg/mL respectively.The Youden index was 0.446 and 0.484,the sensitivity was 0.641 and 0.744,the specificity was 0.805 and 0.740,and the AUC was 0.789 and 0.804.There was no significant difference between the two AUC comparison(Z=0.512,P=0.609).In COVID-19 patients,the risk of VTE increased with increasing score(≥4 points of Padua prediction score)and increased with increasing D-dimer levels,with statistically significant differences(P<0.05).The maximum Yoden index for Padua prediction score combined with D-dimer prediction of VTE was 0.575,with the sensitivity and specificity of 0.795 and 0.780,respectively,and an AUC of 0.863.Compared with Padua prediction score and D-dimer alone,the AUC of the combination was higher and the difference was statistically significant(Z=4.655,P<0.001 and Z=3.606,P<0.001).Conclusion Padua prediction score and D-dimer level may be associated with the risk of VTE in COVID-19 patients.Padua prediction score combined with D-dimer may be having a good predictiv

关 键 词：Padua评分 D-二聚体 COVID-19 静脉血栓栓塞症 

分 类 号：R543.6[医药卫生—心血管疾病] R511[医药卫生—内科学]