Risk factors and development of a risk assessment model for postoperative venous thromboembolism in Cushing′s disease
10.3760/cma.j.cn311282-20230830-00049
- VernacularTitle:库欣病术后静脉血栓栓塞症的危险因素分析及风险评估模型的建立
- Author:
Wenjuan LIU
1
;
Dan LIU
;
Min HE
;
Qing MIAO
;
Lijin JI
;
Lili CHEN
;
Yifei YU
;
Zengyi MA
;
Xuefei SHOU
;
Shuo ZHANG
;
Yutao WANG
;
Zhiyuan WU
;
Chaoyun ZHANG
;
Yao ZHAO
;
Yiming LI
;
Yongfei WANG
;
Hongying YE
Author Information
1. 复旦大学附属华山医院内分泌科，上海 200040
- Keywords:
Cushing′s disease;
Endoscopic transsphenoidal surgery;
Venous thromboembolism;
Risk assessment model
- From:
Chinese Journal of Endocrinology and Metabolism
2024;40(6):487-493
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the incidence and prothrombotic risk factors of postoperative venous thromboembolism(VTE) in Cushing′s disease and to further develop an assessment model to identify those at high risk of postoperative VTE events.Methods:A retrospective study was performed in 82 patients who were admitted to Huashan Hospital, Fudan University during January 2019 and January 2020 and diagnosed with Cushing′s disease. These patients underwent the evaluation about their clinical, hormonal, and coagulation parameters, as well as ultrasonography and pulmonary angio-CT when necessary. The least absolute shrinkage and selection operator(LASSO) regression analysis was used to screen independent risk factors, and a nomogram model for postsurgical VTE risk assessment in Cushing′s disease was initially established, and Bootstrap method was used for internal verification. Finally, the predictive model was evaluated for calibration and clinical applicability in the study cohort.Results:Nineteen patients(23.17%) developed VTE events, with 14 cases occurring after endoscopic transsphenoidal surgery. Compared to patients without VTE, those in the VTE group were older( P<0.001), had longer postoperative bed rest, higher rates of current infection, higher HbA 1C levels, and more severe glucose tolerance impairment(all P<0.05). Through LASSO regression analysis, two independent risk factors for postoperative VTE were identified: Age and current infection. Then a VTE risk assessment nomogram model was established to predict the patients at high risk of VTE. In the nomogram model for VTE risk assessment, the area under the receiver operating characteristic curve was 0.868(95% CI 0.787-0.949), with the calibration curve closely aligning with the ideal diagonal line and the clinical decision curve exceeding the two extreme curves. Conclusions:Advanced perioperative assessment needs to be taken to screen those with high VTE risks in patients diagnosed with Cushing′s disease. Additionally, during the perioperative period, patients with Cushing′s disease should undergo mandatory physical activity or prophylactic anticoagulant therapy.
