在质瘤患者中评估现有的VTE风险尺度
Simakova Maria1, Pishchulov Konstantin1, Lukinov Vitaliy1
1Cardiolooncology Department, Personalized Medicine Centre, Almazov National Medical Research Centre, Sankt-Peterburg, Russian Federation.
概括
已建立的静脉血栓栓塞瘤风险评估模型显示可接受的准确性,但由于较低的积极预测值,对质瘤患者的临床有用性有限. 需要进一步的研究,以改善该群体的VTE预测.
科学领域:
- 神经外科 神经外科
- 在瘤学瘤学.
- 血管外科 血管外科
背景情况:
- 手术后静脉血栓塞栓症 (VTE) 是质瘤患者的重大并发症.
- 现有的风险评估模型 (RAMs) 如Caprini,IMPROVE和Padua在这个特定的患者群体中缺乏验证.
- 准确的VTE风险预测对于优化患者管理和预防并发症至关重要.
研究的目的:
- 评估四种已确定的VTE风险评估模型在质瘤患者中的预测准确度.
- 确定这些模型在神经外科环境中的灵敏度,特异性和积极预测值.
- 确定最适合于瘤手术患者的静脉瘤风险评估工具.
主要方法:
- 一项追溯观察性队列研究,对265名接受手术的质瘤患者进行了追溯观察.
- 验证卡普里尼RAM,IMPROVE风险评分,IMPROVED VTE风险评分和帕多瓦预测评分.
- 接收器操作特征 (ROC) 分析以确定最佳值并计算曲线下的面积 (AUC).
- 使用DeLong测试对AUC值和其他性能指标进行比较.
主要成果:
- 所有四种VTE风险评估模型都显示了可接受的敏感性和特异性.
- 在ROC曲线下的面积 (AUC) 从72.58到80.41不等,模型之间没有显著差异.
- 在所有模型中,积极预测值 (PPV) 始终很低,这表明准确识别患有VTE的患者的能力有限.
结论:
- 虽然Caprini,IMPROVE和帕多亚风险评分对一般人群进行了验证,但它们在脑瘤患者的神经外科实践中具有有限的临床实用性.
- 这些模型的低正预测能力阻碍了它们在预测VTE的实际应用.
- 进一步开发针对神经外科患者量身定制的VTE风险评估工具是有必要的.
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