Optimization study on predicting VTE of inpatients in respiratory medicine department based on Padua score_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

SHEN Wei , SHI Pengfei , WANG Baolan , MA Ting , ZHU Rong ,  WANG Lixin

Department of Respiratory and Critical Care Medicine, Huai’an First People’s Hospital, Nanjing Medical University, Jiangsu 223001, P.R.China;

Corresponding author：

WANG Lixin, Email: wlxhunter923@163.com

Keywords：

venous thromboembolism; Padua scale; Improved Padua scale

DOI：

10.7507/1671-6205.202409017

Video：

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Objective To explore the correlation between risk factors in respiratory department patients and the occurrence of venous thromboembolism (VTE), and to evaluate the optimization of the Padua score for predicting VTE occurrence in hospitalized respiratory patients based on these correlations. The effectiveness of the modified assessment model for VTE prediction was also validated. Methods A retrospective study was conducted, involving 51 VTE patients who were hospitalized in the Respiratory Department of Huaian First People’s Hospital from March 2019 to July 2023. These patients were compared with 1,600 non-VTE patients who were discharged during the same period. Clinical data, including medical history and laboratory test results, were retrospectively collected from both groups. The correlation between clinical data and VTE occurrence was analyzed, and highly relevant risk factors were incorporated into the Padua score. The modified Padua risk assessment model was applied to all patients and validated in a validation group. The scores from both the original and modified risk assessment models were compared to evaluate the effectiveness of the modified Padua score. Results Rank sum tests showed significant differences in basic information, such as age, BMI, and length of hospital stay, as well as laboratory tests including mean corpuscular volume, procalcitonin, albumin, alanine aminotransferase, aspartate aminotransferase, urea, and D-dimer (P<0.05). Univariate and multivariate logistic regression analyses revealed that newly identified high-risk factors for VTE included hypoalbuminemia (OR=2.972), blood transfusion (OR=47.035), and mechanical ventilation (OR=6.782) (P<0.05). Receiver operating characteristic curve analysis showed that the sensitivity and specificity of the modified Padua score were higher than those of the original version. The area under the curve (AUC) difference was 0.058, with a Z-test value of 2.442, showing statistical significance (P<0.05). Conclusions The modified Padua score demonstrated superior predictive ability for VTE in hospitalized respiratory patients compared to the original Padua score.

Citation： SHEN Wei, SHI Pengfei, WANG Baolan, MA Ting, ZHU Rong, WANG Lixin. Optimization study on predicting VTE of inpatients in respiratory medicine department based on Padua score. Chinese Journal of Respiratory and Critical Care Medicine, 2024, 23(12): 856-863. doi: 10.7507/1671-6205.202409017 Copy

1.	ISTH Steering Committee for World Thrombosis Day. Thrombosis: a major contributor to global disease burden. Thromb Res, 2014, 134(5): 931-938.
2.	Wendelboe AM, Raskob GE. Global Burden of Thrombosis: Epidemiologic Aspects. Circ Res. 2016 Apr 29;118(9): 1340-1347.
3.	Al-Hameed F, Al-Dorzi HM, Aboelnazer E. The effect of a continuing medical education program on Venous thromboembolism prophylaxis utilization and mortality in a tertiary-care hospital. Thromb J. 2014 Apr 28;12: 9.
4.	Vardi M, Ghanem-Zoubi NO, Zidan R, et al. Venous thromboembolism and the utility of the Padua Prediction Score in patients with sepsis admitted to internal medicine departments. J Thromb Haemost. 2013 Mar;11(3): 467-473.
5.	Khan F, Tritschler T, Kahn SR, et al. Venous thromboembolism. Lancet. 2021 Jul 3;398(10294): 64-77.
6.	《内科住院患者静脉血栓栓塞症预防的中国专家建议》写作组, 中华医学会老年医学分会, 中华医学会呼吸病学分会, 等. 内科住院患者静脉血栓栓塞症预防中国专家建议(2015). 中华老年医学杂志, 2015, 34(4): 345-352.
7.	王欣, 洪新宇, 李金玉, 等. Padua风险评估模型对内科住院患者静脉血栓栓塞症的评估价值. 协和医学杂志, 2018, 9(3): 234-241.
8.	Barbar S, Noventa F, Rossetto V, et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. J Thromb Haemost, 2010, 8(11): 2450-2457.
9.	Oger E. Incidence of venous thromboembolism: a community-based study in Western France. EPI-GETBP Study Group. Groupe d'Etude de la Thrombose de Bretagne Occidentale. Thromb Haemost, 2000, 83(5): 657-560.
10.	Zakai NA, McClure LA. Racial differences in venous thromboembolism. J Thromb Haemost. 2011 Oct;9(10): 1877-1882.
11.	Liu X, Jiao X, Gong X, et al. Prevalence, Risk Factor and Clinical Characteristics of Venous Thrombus Embolism in Patients with Acute Exacerbation of COPD: A Prospective Multicenter Study. Int J Chron Obstruct Pulmon Dis, 2023, 18: 907-917.
12.	Yang C, Tuo Y, Shi X, et al. Prevalence, risk factors, and clinical characteristics of pulmonary embolism in patients with acute exacerbation of COPD in Plateau regions: a prospective cohort study. BMC Pulm Med, 2024, 24(1): 102.
13.	Li HL, Zhang H, Chan YC, Cheng SW. Prevalence and risk factors of hospital acquired venous thromboembolism. Phlebology. 2024, 2683555241297566. Online ahead of print.
14.	Francis C , Laurent B , Jean P , et al. Prevalence of Pulmonary Embolism Among Patients With COPD Hospitalized With Acutely Worsening Respiratory Symptoms. JAMA, 2021, 325(1): 59-68.
15.	盛海燕, 金建敏, 刘晓芳, 等. 呼吸科低氧血症患者肺血栓栓塞症的发生及临床特征研究. 国际呼吸杂志, 2018, 38(4): 276-284.
16.	Nicolas H , Benoit B , Samuel W , et al. Incidence and Risk Factors of Venous Thromboembolic Events in Patients with ANCA-Glomerulonephritis: A Cohort Study from the Maine-Anjou Registry. clinical med, 2020, 9(10): 3177-3177.
17.	Xin X, Huang H, Lu W, et al. Albumin concentration is a candidate indicator for predicting the risk of calf venous thromboembolism in patients undergoing gynecologic surgery. Int J Gynaecol Obstet, 2022, 56(1): 139-144.
18.	Marongiu F, Mameli A, Grandone E, et al. Pulmonary Thrombosis: A Clinical Pathological Entity Distinct from Pulmonary Embolism? Semin Thromb Hemost. 2019, 45(8): 778-783.
19.	Nemeth B, Smeets MJR, Cannegieter SC, et al. Tutorial: dos and don'ts in clinical prediction research for venous thromboembolism. Res Pract Thromb Haemost, 2024, 8(4): 102480.
20.	Chen K, Shen Z, Gu W, et al. Meinian Investigator Group. Prevalence of obesity and associated complications in China: A cross-sectional, real-world study in 15.8 million adults. Diabetes Obes Metab. 2023, 25(11): 3390-3399.
21.	Zhai Z, Kan Q, Li W, et al. DissolVE-2 investigators. VTE Risk Profiles and Prophylaxis in Medical and Surgical Inpatients: The Identification of Chinese Hospitalized Patients' Risk Profile for Venous Thromboembolism (DissolVE-2)-A Cross-sectional Study. Chest. 2019, 155(1): 114-122.
22.	彭清, 刘佳君, 刘焱, 等. Padua预测评分和血清白蛋白水平在评估风湿病住院患者静脉血栓栓塞中的应用. 北京大学学报(医学版), 2023, 55(4): 625-630.
23.	Gyamlani G, Molnar MZ, Lu JL, et al. Association of serum albumin level and venous thromboembolic events in a large cohort of patients with nephrotic syndrome. Nephrol Dial Transplant. 2017, 32(1): 157-164.
24.	王少飞. 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. 临床肺科杂志, 2023, 28(12): 1831-1835.
25.	董清, 成孟瑜. Padua评分联合D-dimer对呼吸内科住院患者VTE的风险评估价值研究. 临床肺科杂志, 2024, 29(4): 501-506.
26.	Yonathan F , Anthony C , Sonia J , et al. Effect of a Diagnostic Strategy Using an Elevated and Age-Adjusted D-Dimer Threshold on Thromboembolic Events in Emergency Department Patients With Suspected Pulmonary Embolism: A Randomized Clinical Trial. JAMA, 2021, 326(21): 2141-2149.
27.	Chen L, Zhang W, Liu C. Combination of D-dimer and Albumin in the Prediction of Deep Vein Thrombosis in Patients with Spontaneous Intracerebral Hemorrhage. Clin Appl Thromb Hemost. 2023, 29: 10760296231165054.
28.	Białas AJ, Kornicki K, Ciebiada M, et al. Monocyte to large platelet ratio as a diagnostic tool for pulmonary embolism in patients with acute exacerbation of chronic obstructive pulmonary disease. Pol Arch Intern Med, 2018, 128(1): 15-23.
29.	Christos K , Athena G , Konstantinos K , et al. Hypercoagulable State in COPD-A Comprehensive Literature Review. Diagnostics, 2021, 11(8): 1447-1447.
30.	Sneeboer MMS, Hutten BA, Majoor CJ, et al. Oral and inhaled corticosteroid use and risk of recurrent pulmonary embolism. Thromb Res, 2016, 140: 46-50.

1. ISTH Steering Committee for World Thrombosis Day. Thrombosis: a major contributor to global disease burden. Thromb Res, 2014, 134(5): 931-938.
2. Wendelboe AM, Raskob GE. Global Burden of Thrombosis: Epidemiologic Aspects. Circ Res. 2016 Apr 29;118(9): 1340-1347.
3. Al-Hameed F, Al-Dorzi HM, Aboelnazer E. The effect of a continuing medical education program on Venous thromboembolism prophylaxis utilization and mortality in a tertiary-care hospital. Thromb J. 2014 Apr 28;12: 9.
4. Vardi M, Ghanem-Zoubi NO, Zidan R, et al. Venous thromboembolism and the utility of the Padua Prediction Score in patients with sepsis admitted to internal medicine departments. J Thromb Haemost. 2013 Mar;11(3): 467-473.
5. Khan F, Tritschler T, Kahn SR, et al. Venous thromboembolism. Lancet. 2021 Jul 3;398(10294): 64-77.
6. 《内科住院患者静脉血栓栓塞症预防的中国专家建议》写作组, 中华医学会老年医学分会, 中华医学会呼吸病学分会, 等. 内科住院患者静脉血栓栓塞症预防中国专家建议(2015). 中华老年医学杂志, 2015, 34(4): 345-352.
7. 王欣, 洪新宇, 李金玉, 等. Padua风险评估模型对内科住院患者静脉血栓栓塞症的评估价值. 协和医学杂志, 2018, 9(3): 234-241.
8. Barbar S, Noventa F, Rossetto V, et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. J Thromb Haemost, 2010, 8(11): 2450-2457.
9. Oger E. Incidence of venous thromboembolism: a community-based study in Western France. EPI-GETBP Study Group. Groupe d'Etude de la Thrombose de Bretagne Occidentale. Thromb Haemost, 2000, 83(5): 657-560.
10. Zakai NA, McClure LA. Racial differences in venous thromboembolism. J Thromb Haemost. 2011 Oct;9(10): 1877-1882.
11. Liu X, Jiao X, Gong X, et al. Prevalence, Risk Factor and Clinical Characteristics of Venous Thrombus Embolism in Patients with Acute Exacerbation of COPD: A Prospective Multicenter Study. Int J Chron Obstruct Pulmon Dis, 2023, 18: 907-917.
12. Yang C, Tuo Y, Shi X, et al. Prevalence, risk factors, and clinical characteristics of pulmonary embolism in patients with acute exacerbation of COPD in Plateau regions: a prospective cohort study. BMC Pulm Med, 2024, 24(1): 102.
13. Li HL, Zhang H, Chan YC, Cheng SW. Prevalence and risk factors of hospital acquired venous thromboembolism. Phlebology. 2024, 2683555241297566. Online ahead of print.
14. Francis C , Laurent B , Jean P , et al. Prevalence of Pulmonary Embolism Among Patients With COPD Hospitalized With Acutely Worsening Respiratory Symptoms. JAMA, 2021, 325(1): 59-68.
15. 盛海燕, 金建敏, 刘晓芳, 等. 呼吸科低氧血症患者肺血栓栓塞症的发生及临床特征研究. 国际呼吸杂志, 2018, 38(4): 276-284.
16. Nicolas H , Benoit B , Samuel W , et al. Incidence and Risk Factors of Venous Thromboembolic Events in Patients with ANCA-Glomerulonephritis: A Cohort Study from the Maine-Anjou Registry. clinical med, 2020, 9(10): 3177-3177.
17. Xin X, Huang H, Lu W, et al. Albumin concentration is a candidate indicator for predicting the risk of calf venous thromboembolism in patients undergoing gynecologic surgery. Int J Gynaecol Obstet, 2022, 56(1): 139-144.
18. Marongiu F, Mameli A, Grandone E, et al. Pulmonary Thrombosis: A Clinical Pathological Entity Distinct from Pulmonary Embolism? Semin Thromb Hemost. 2019, 45(8): 778-783.
19. Nemeth B, Smeets MJR, Cannegieter SC, et al. Tutorial: dos and don'ts in clinical prediction research for venous thromboembolism. Res Pract Thromb Haemost, 2024, 8(4): 102480.
20. Chen K, Shen Z, Gu W, et al. Meinian Investigator Group. Prevalence of obesity and associated complications in China: A cross-sectional, real-world study in 15.8 million adults. Diabetes Obes Metab. 2023, 25(11): 3390-3399.
21. Zhai Z, Kan Q, Li W, et al. DissolVE-2 investigators. VTE Risk Profiles and Prophylaxis in Medical and Surgical Inpatients: The Identification of Chinese Hospitalized Patients' Risk Profile for Venous Thromboembolism (DissolVE-2)-A Cross-sectional Study. Chest. 2019, 155(1): 114-122.
22. 彭清, 刘佳君, 刘焱, 等. Padua预测评分和血清白蛋白水平在评估风湿病住院患者静脉血栓栓塞中的应用. 北京大学学报(医学版), 2023, 55(4): 625-630.
23. Gyamlani G, Molnar MZ, Lu JL, et al. Association of serum albumin level and venous thromboembolic events in a large cohort of patients with nephrotic syndrome. Nephrol Dial Transplant. 2017, 32(1): 157-164.
24. 王少飞. 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. 临床肺科杂志, 2023, 28(12): 1831-1835.
25. 董清, 成孟瑜. Padua评分联合D-dimer对呼吸内科住院患者VTE的风险评估价值研究. 临床肺科杂志, 2024, 29(4): 501-506.
26. Yonathan F , Anthony C , Sonia J , et al. Effect of a Diagnostic Strategy Using an Elevated and Age-Adjusted D-Dimer Threshold on Thromboembolic Events in Emergency Department Patients With Suspected Pulmonary Embolism: A Randomized Clinical Trial. JAMA, 2021, 326(21): 2141-2149.
27. Chen L, Zhang W, Liu C. Combination of D-dimer and Albumin in the Prediction of Deep Vein Thrombosis in Patients with Spontaneous Intracerebral Hemorrhage. Clin Appl Thromb Hemost. 2023, 29: 10760296231165054.
28. Białas AJ, Kornicki K, Ciebiada M, et al. Monocyte to large platelet ratio as a diagnostic tool for pulmonary embolism in patients with acute exacerbation of chronic obstructive pulmonary disease. Pol Arch Intern Med, 2018, 128(1): 15-23.
29. Christos K , Athena G , Konstantinos K , et al. Hypercoagulable State in COPD-A Comprehensive Literature Review. Diagnostics, 2021, 11(8): 1447-1447.
30. Sneeboer MMS, Hutten BA, Majoor CJ, et al. Oral and inhaled corticosteroid use and risk of recurrent pulmonary embolism. Thromb Res, 2016, 140: 46-50.

Chinese Journal of Respiratory and Critical Care Medicine

Optimization study on predicting VTE of inpatients in respiratory medicine department based on Padua score

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