Value of a risk assessment model in predicting venous thromboembolism in patients with liver failure after artificial liver support therapy

Sufang LU; Rui HUANG; Hongli ZHAO; Dandan WANG; Yuzhen DING; Hong ZHOU

doi:10.3969/j.issn.1001-5256.2023.03.019

Volume 39 Issue 3

Mar. 2023

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Article Navigation > Journal of Clinical Hepatology > 2023 > 39(3): 613-619

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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

Department of Infectious Diseases, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China

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

Abstract

Abstract

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.
- Liver Failure,
- Venous Thromboembolism,
- Liver, Artificial,
- Risk Factors,
- Models, Statistical

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References(18)

References

[1]	RAPP CM, SHIELDS EJ, WIATER BP, et al. Venous thromboembolism after shoulder arthoplasty and arthroscopy[J]. J Am Acad Orthop Surg, 2019, 27(8): 265-274. DOI: 10.5435/JAAOS-D-17-00763.
[2]	WANG Q, DING J, YANG R. The venous thromboembolism prophylaxis in patients receiving thoracic surgery: A systematic review[J]. Asia Pac J Clin Oncol, 2021, 17(5): e142-e152. DOI: 10.1111/ajco.13386.
[3]	SI N, LIU F, LIU L, et al. Effect of platelet level and platelet parameters on the prognosis of patients with acute-on-chronic liver failure[J]. J Clin Hepatol, 2022, 38(2): 381-386. DOI: 10.3969/j.issn.1001-5256.2022.02.023. 司诺, 刘芳, 刘磊, 等. PLT水平及PLT参数对慢加急性肝衰竭患者预后的影响[J]. 临床肝胆病杂志, 2022, 38(2): 381-386. DOI: 10.3969/j.issn.1001-5256.2022.02.023.
[4]	ZHOU L, CHEN Y. Model selection and curative effect judgment criteria for artificial liver in the treatment of liver failure[J]. Chin J Hepatol, 2022, 30(2): 127-130. DOI: 10.3760/cma.j.cn501113-20220108-00008. 周莉, 陈煜. 人工肝治疗肝衰竭模式选择及其疗效判断标准[J]. 中华肝脏病杂志, 2022, 30(2): 127-130. DOI: 10.3760/cma.j.cn501113-20220108-00008.
[5]	WANG L, XU WX, ZHU Z, et al. Influence of artificial liver support system therapy on platelet in treatment of hepatitis B virus-related acute-on-chronic liver failure[J]. J Clin Hepatol, 2022, 38(5): 1053-1058. DOI: 10.3969/j.issn.1001-5256.2022.05.015. 王璐, 许文雄, 朱姝, 等. 人工肝治疗HBV相关慢加急性肝衰竭的血小板计数变化及其影响因素[J]. 临床肝胆病杂志, 2022, 38(5): 1053-1058. DOI: 10.3969/j.issn.1001-5256.2022.05.015.
[6]	Liver failure and artificial liver group of infectious diseases branch of Chinese Medical Association, severe liver disease and artificial liver group of Hepatology branch of Chinese Medical Association. Diagnostic and treatment guidelines for liver failure (2012 version)[J]. Chin J Clin Infect Dis, 2012, 5(6): 321-327. DOI: 10.3760/cma.j.issn.1674-2397.2012.06.001. 中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南(2012年版)[J]. 中华临床感染病杂志, 2012, 5(6): 321-327. DOI: 10.3760/cma.j.issn.1674-2397.2012.06.001.
[7]	WU B, DU LY, MA YJ, et al. Effects of different combinations of artificial liver support system on efficacy and inflammatory indexes of patients with hepatitis B virus-related acute-on-chronic liver failure in early and middle stages[J/CD]. Chin J Liver Dis (Electronic Version), 2021, 13(1): 32-38. DOI: 10.3969/j.issn.1674-7380.2021.01.006. 吴蓓, 杜凌遥, 马元吉, 等. 不同组合人工肝支持系统治疗乙型肝炎病毒相关早、中期慢加急性肝衰竭患者的疗效及对炎症指标的影响[J/CD]. 中国肝脏病杂志(电子版), 2021, 13(1): 32-38. DOI: 10.3969/j.issn.1674-7380.2021.01.006.
[8]	NANCHAL R, SUBRAMANIAN R, KARVELLAS CJ, et al. Guidelines for the management of adult acute and acute-on-chronic liver failure in the ICU: Cardiovascular, endocrine, hematologic, pulmonary, and renal considerations[J]. Crit Care Med, 2020, 48(3): e173-e191. DOI: 10.1097/CCM.0000000000004192.
[9]	MAP YQ, ZHOU XS, WANG X, et al. Study on the correlation between antithrombin Ⅲ activity and short-term prognosis of acute-on-chronic liver failure patients treated with artificial liver support system[J]. Chin Hepatol, 2021, 26(7): 770-775. DOI: 10.3969/j.issn.1008-1704.2021.07.016. 毛燕群, 周学士, 王霞, 等. 抗凝血酶Ⅲ活性与慢加急性肝衰竭患者人工肝治疗结局的相关性[J]. 肝脏, 2021, 26(7): 770-775. DOI: 10.3969/j.issn.1008-1704.2021.07.016.
[10]	PENG H, XU FF, WAN XQ, et al. Clinical efficacy of artificial liver plasma exchange in treatment of patients with severe hepatitis and influencing factors for prognosis[J]. Clin Misdiagn Misther, 2021, 34(5): 90-95. DOI: 10.3969/j.issn.1002-3429.2021.05.018. 彭欢, 许菲菲, 万小秋, 等. 人工肝血浆置换治疗重型肝炎效果及其预后影响因素分析[J]. 临床误诊误治, 2021, 34(5): 90-95. DOI: 10.3969/j.issn.1002-3429.2021.05.018.
[11]	WANG DG, TAN CL, WANG HY, et al. Predictive value of thromboelastogram for postoperative venous thromboembolism in breast cancer patients[J]. Chin J Curr Adv Gen Surg, 2022, 25(1): 23-26, 48. DOI: 10.3969/j.issn.1009-9905.2022.01.005. 王德光, 谭春玲, 王洪燕, 等. 血栓弹力图对乳腺癌术后静脉血栓栓塞症的预测价值[J]. 中国现代普通外科进展, 2022, 25(1): 23-26, 48. DOI: 10.3969/j.issn.1009-9905.2022.01.005.
[12]	ZHANG L, HE JX, FAN XS, et al. Prognostic value of antithrombin Ⅲ activity combined with CLIF-C OFs score in patients with HBV related chronic plus acute liver failure[J]. Chin J Difficult Comp Cases, 2022, 21(1): 36-40, 45. DOI: 10.3969/j.issn.1671-6450.2022.01.007. 张蕾, 贺建勋, 范雪松, 等. 抗凝血酶Ⅲ活性联合CLIF-C OFs评分对HBV相关慢加急性肝衰竭患者预后的评估价值[J]. 疑难病杂志, 2022, 21(1): 36-40, 45. DOI: 10.3969/j.issn.1671-6450.2022.01.007.
[13]	YANG P, XIAO LR, YANG N, et al. The evaluation value of procalcitonin and prothrombin activity in the prognosis of liver failure complicated by infection[J]. Chin J Nosocomiol, 2022, 32(4): 531-534. DOI: 10.11816/cn.ni.2022-210509. 杨平, 肖乐尧, 杨娜, 等. 降钙素原和凝血酶原活动度在肝衰竭合并感染预后中的评估价值[J]. 中华医院感染学杂志, 2022, 32(4): 531-534. DOI: 10.11816/cn.ni.2022-210509.
[14]	WU XJ, ZHAO WL, SU ZZ, et al. Application value of antithrombin Ⅲ in evaluating the disease progression and 28-day mortality of patients with HBV-associated acute-on-chronic liver failure[J]. Chin J Clin Lab Sci, 2020, 38(6): 458-463. DOI: 10.13602/j.cnki.jcls.2020.06.18. 吴晓娟, 赵文玲, 苏真珍, 等. 抗凝血酶Ⅲ评价HBV感染相关慢加急性肝衰竭患者疾病进展和28天死亡率的应用价值[J]. 临床检验杂志, 2020, 38(6): 458-463. DOI: 10.13602/j.cnki.jcls.2020.06.18.
[15]	LIN Y, ZENG Z, LIN R, et al. The Caprini thrombosis risk model predicts the risk of peripherally inserted central catheter-related upper extremity venous thrombosis in patients with cancer[J]. J Vasc Surg Venous Lymphat Disord, 2021, 9(5): 1151-1158. DOI: 10.1016/j.jvsv.2020.12.075.
[16]	ZHOU J, WANG QY, QIN CL. Analysis of risk factors for venous thromboembolism after operation of primary liver cancer and application of Caprini risk prediction model[J]. Mod Oncol, 2022, 30(12): 2214-2218. DOI: 10.3969/j.issn.1672-4992.2022.12.021. 周建, 王庆元, 秦长岭. 原发性肝癌术后发生静脉血栓栓塞症的危险因素及Caprini风险预测模型的应用[J]. 现代肿瘤医学, 2022, 30(12): 2214-2218. DOI: 10.3969/j.issn.1672-4992.2022.12.021.
[17]	MENG R, MA CY. Practice and effect of Caprini risk assessment model in prevention of deep venous thrombosis in ICU patients[J]. Chin J Thromb Hemost, 2017, 23(6): 1054-1056. DOI: 10.3969/j.issn.1009-6213.2017.06.057. 孟蕊, 马春园. Caprini风险评估模型在预防ICU患者深静脉血栓中的实践效果[J]. 血栓与止血学, 2017, 23(6): 1054-1056. DOI: 10.3969/j.issn.1009-6213.2017.06.057.
[18]	QIAO Y, GUO P, WANG L. Validityan alysis of Caprini thrombosis assessment scale in assessing the risk of venous thromboembolism in liver failure patients treated with artificial liver[J]. Acta Acad Med Bengbu, 2020, 45(1): 120-123. DOI: 10.13898/j.cnki.issn.1000-2200.2020.01.031. 乔艳, 郭普, 王丽. Caprini血栓风险评估量表预测人工肝治疗肝衰竭病人静脉血栓栓塞症风险有效性分析[J]. 蚌埠医学院学报, 2020, 45(1): 120-123. DOI: 10.13898/j.cnki.issn.1000-2200.2020.01.031.

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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

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