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Predictive Value of Cardiac Biomarkers Combined with Clinical, Radiological Factors for Venous Thromboembolism in
Mengyuan Yuan1, Xiguang Fu2,3, Tong Chen1
1Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Insights
Cardiac biomarkers like myoglobin (Myo) and B-type natriuretic peptide (BNP) significantly improve venous thromboembolism (VTE) risk prediction in patients with intracerebral hemorrhage (ICH). A new nomogram integrates these with clinical factors for better VTE risk stratification.
Area of Science:
- Neurology
- Cardiology
- Hematology
Background:
- Venous thromboembolism (VTE) is a significant complication following spontaneous intracerebral hemorrhage (ICH).
- Accurate identification of high-risk ICH patients for VTE remains a clinical challenge.
Purpose of the Study:
- To develop and validate a predictive model for VTE risk in ICH patients.
- Integrate cardiac biomarkers with clinical and radiological factors for enhanced risk assessment.
Main Methods:
- Retrospective enrollment of 170 ICH patients (Oct 2019-Dec 2022).
- Collection of clinical, laboratory, and radiological data.
- Development of a nomogram using Cox regression analysis for VTE prediction.
Main Results:
- Age, edema volume, intraventricular hemorrhage, myoglobin (Myo), and B-type natriuretic peptide (BNP) were independent VTE predictors.
- The combined model (C-index: 0.791) outperformed the clinical-radiological model (C-index: 0.749).
- The nomogram demonstrated good calibration and clinical utility.
Conclusions:
- Myoglobin and BNP offer incremental predictive value for VTE risk in ICH patients.
- The developed nomogram serves as a practical tool for individualized VTE risk assessment.
- This tool may guide optimized VTE prophylaxis strategies in ICH patients.
Introduction:
Venous thromboembolism (VTE) is an important complication after spontaneous intracerebral hemorrhage (ICH). However, it remains a clinical challenge to identify individuals at high risk for VTE in a population with ICH. This study aimed to develop a model integrating cardiac biomarkers with clinical-radiological factors for predicting VTE risk in patients with spontaneous ICH.
Methods:
ICH patients were retrospectively enrolled between October 2019 and December 2022. Baseline clinical characteristics, laboratory data, and radiological features were collected. Patients with pulmonary embolism (PE) and deep vein thrombosis were classified into the VTE group. Cox regression analysis was used to identify independent predictors of in-hospital VTE. A nomogram was developed based on the multivariate model, and its performance was evaluated using the concordance index (C-index), decision curve analysis, and net reclassification improvement.
Results:
A total of 170 patients (mean age: 54.66 ± 13.6 years, 125 [73.5%] males) with ICH were included in the analysis. Thirty-six (21.2%) patients were assigned to the VTE group. Multivariate Cox analysis identified age (HR = 1.032, 95% CI: 1.002-1.062, p = 0.033), baseline edema volume (HR = 1.034, 95% CI: 1.012-1.056, p = 0.002), intraventricular hemorrhage (HR = 3.268, 95% CI: 1.635-6.530, p < 0.001), myoglobin (Myo; HR = 1.002, 95% CI: 1.000-1.003, p = 0.010), and B-type natriuretic peptide (BNP; HR = 1.003, 95% CI: 1.001-1.006, p = 0.007) as independent predictors. The combined model showed better predictive performance than the clinical-radiological model alone (C-index: 0.791 vs. 0.749). The nomogram demonstrated good calibration and clinical utility across a wide risk threshold range.
Conclusion:
Myo and BNP provide incremental predictive value for VTE risk stratification in ICH patients beyond traditional factors. The developed nomogram offers a practical tool for individualized risk assessment, potentially guiding optimized VTE prophylaxis strategies.
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