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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 39 Issue 3
Mar.  2023
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Value of a risk assessment model in predicting venous thromboembolism in patients with liver failure after artificial liver support therapy

DOI: 10.3969/j.issn.1001-5256.2023.03.019
Research funding:

Research funding: National Natural Science Foundation of China (81702011);

Research Project of Modern Hospital Management and Development Institute of Nanjing University and Medical Development and Medical Assistance Fund of Nanjing Drum Tower Hospital (NDYG2021016)

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  • Corresponding author: LU Sufang, sufanglu0708@126.com (ORCID: 0000-0001-5471-2511)
  • Received Date: 2022-08-01
  • Accepted Date: 2022-10-11
  • Published Date: 2023-03-20
  •   Objective  To investigate the value of a risk assessment model in predicting venous thromboembolism (VTE) in patients with liver failure after artificial liver support therapy.   Methods  A retrospective analysis was performed for the clinical data of 124 patients with liver failure who received artificial liver support therapy in Affiliated Drum Tower Hospital of Nanjing University Medical School from March 2019 to December 2021, among whom there were 41 patients with VTE (observation group) and 143 patients without VTE (control group). Related clinical data were compared between the two groups, and the Caprini risk assessment model was used for scoring and risk classification of the patients in both groups. The t-test was used for comparison of continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups; the Mann-Whitney U rank sum test was used for comparison of ranked data between two groups. The logistic regression analysis was used to investigate the independent risk factors for VTE in patients with liver failure after artificial liver support therapy. The receiver operating characteristic (ROC) curve was used to investigate the value of Caprini score and the multivariate predictive model used alone or in combination in predicting VTE.  Results  The observation group had a significantly higher Caprini score than the control group (4.39±1.10 vs 3.12±1.04, t=6.805, P < 0.001). There was a significant difference between the two groups in risk classification based on Caprini scale (P < 0.05), and the patients with high risk or extremely high risk accounted for a higher proportion among the patients with VTE. The univariate analysis showed that there were significant differences between the two groups in age (t=6.400, P < 0.001), catheterization method (χ2=14.413, P < 0.001), number of times of artificial liver support therapy (Z=-4.720, P < 0.001), activity (Z=-6.282, P < 0.001), infection (χ2=33.071, P < 0.001), D-dimer (t=8.746, P < 0.001), 28-day mortality rate (χ2=5.524, P=0.022). The multivariate analysis showed that number of times of artificial liver support therapy (X1) (odds ratio [OR]=0.251, 95% confidence interval [CI]: 0.111-0.566, P=0.001), activity (X2) (OR=0.122, 95%CI: 0.056-0.264, P < 0.001), D-dimer (X3) (OR=2.921, 95%CI: 1.114-7.662, P=0.029) were independent risk factors for VTE in patients with liver failure after artificial liver support therapy. The equation for individual predicted probability was P=1/[1+e-(7.425-1.384X1-2.103X2+1.072X3)]. The ROC curve analysis showed that Caprini score had an area under the ROC curve of 0.802 (95%CI: 0.721-0.882, P < 0.001), and the multivariate model had an area under the ROC curve of 0.768 (95%CI: 0.685-0.851, P < 0.001), while the combination of Caprini score and the multivariate model had an area under the ROC curve of 0.957 (95%CI: 0.930-0.984, P < 0.001).  Conclusion  The Caprini risk assessment model has a high predictive efficiency for the risk of VTE in patients with liver failure after artificial liver support therapy, and its combination with the multivariate predictive model can significantly improve the prediction of VTE.

     

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