Derivation and External Validation of a Risk Assessment Model of Venous Thromboembolism in Hospitalized Chinese Patients

Abstract

Aim To develop and validate a risk assessment model (RAM) of venous thromboembolism (VTE) in hospitalized Chinese patients. Methods We reviewed data from 300 patients with VTE and 300 non-VTE patients at Beijing Shijitan Hospital. The risk factors related to VTE were analyzed, and the VTE RAM (Shijitan (SJT) version) was developed according to the weight of each risk factor. A total of 407 patients with VTE and 533 non-VTE patients were enrolled for external validation. The sensitivity, specificity, Youden index, receiver operating curve (ROC), and area under the ROC curve (AUC) were used to evaluate the performance of VTE RAM (SJT version) compared with Caprini RAM and Padua RAM. Results The VTE RAM (SJT version) contained six risk factors (age >60 years, lower limb edema, chronic obstructive pulmonary disease (COPD), central venous catheterization (CVC), VTE history, and D dimer). In the external validation group, for medical patients, the AUC value of SJT RAM (0.82 ± 0.03) is significantly higher than Caprini RAM (0.76 ± 0.04; P < 0.05), SJT RAM has a higher sensitivity, specificity, and Youden index than Caprini RAM ( P < 0.05), which means that the SJT RAM has a much better predictive value than Caprini RAM. While SJT RAM and Padua RAM have the similar predictive value for medical patients ( P > 0.05). For surgical patients, the AUC value of SJT RAM (0.72 ± 0.04) is significantly higher than the value of Padua RAM (0.66 ± 0.04; P < 0.05), SJT RAM has a higher sensitivity, specificity, and Youden index than Padua RAM ( P < 0.05), which shows that the VTE RAM has better predictive value than Padua RAM. While SJT RAM and Caprini RAM have the similar predictive value for surgical patients ( P > 0.05). Conclusion The SJT RAM derived from general hospitalized Chinese patients will be time-saving for physicians and has a better predictive ability for patients at risk of VTE.

Distinct age‐adjusted D‐dimer threshold to rule out acute pulmonary embolism in outpatients and inpatients

“…Clinical suspicion of PE defined as the presence of any of the following: unexplainable dyspnea, chest pain, hemoptysis, syncope, palpitation, cyanosis, asymmetric swelling of lower limbs, or previous history of VTE; exclusion criteria are as follows: (1) PE suspicion was raised more than 24 h after admission to the hospital in outpatient and less than 2 days of hospitalization in inpatient; (2) Aged <18 years old; (3) PE was suspected, but the patient received anticoagulation therapy for other reasons (such as atrial fibrillation); (4) missing data (CTPA, DD, or clinical data); (5) ongoing pregnancy (shown in Figure 1 ). 3 , 11 Clinical probability was assessed using the simplified Wells score, and CTPA was performed as the gold standard test for PE. Patients were divided into PE and non‐PE groups based on the CTPA results and into inpatient and outpatient groups based on the source of recruitment.…”

External Validation of the Risk Assessment Model of Venous Thromboembolism in Multicenter Internal Medicine Inpatients

“…We developed the VTE risk assessment model (SJT model) based on hospitalized patients in a comprehensive hospital and external validated prospectively. 3 We want to explore the clinical effectiveness of the SJT RAM in multicenter internal medicine patients.…”