静脉血栓栓塞后3个月和12个月的功能障碍：一项队列研究

Functional limitations 3 and 12 months after venous thromboembolism: a cohort study

Research and Practice in Thrombosis and Haemostasis

影响因子:3.4

分区:医学3区 / 血液学3区外周血管病3区

发表日期:2024 May

作者: Daniel Steiner, Stephan Nopp, Georg Heinze, Daniel Kraemmer, Oliver Schlager, Stefano Barco, Frederikus A Klok, Ingrid Pabinger, Benedikt Weber, Cihan Ay

DOI: 10.1016/j.rpth.2024.102464

摘要

静脉血栓栓塞（VTE）与多种长期并发症相关。我们旨在研究VTE诊断时的临床特征与其后3个月和12个月的功能障碍之间的关系。我们进行了一项VTE患者的前瞻性队列研究，排除了癌症、妊娠及产后期患者。功能障碍通过VTE后功能状态（PVFS）量表（范围0-4）进行评估，时间点包括诊断后21天内（诊断时点的回顾性评估）、3个月和12个月（前瞻性评估），以及诊断前1个月（回顾性评估）。12个月的随访仅在接受抗凝治疗的患者中进行。我们为3个月和12个月的随访建立了两个比例序数逻辑回归模型，计算了比值比（OR）及其95%的自助法百分位置信赖区间（CI）。我们共纳入307名患者（女性占42%，中位年龄55.6岁），在研究入组时PVFS评分中位数（IQR）为2（2-3），诊断前为0（0-0）。3个月后，269名患者的PVFS评分为1（0-2）。女性（OR，2.15；95% CI，1.26-4.14）、体质指数（每增加1 kg/m2，OR，1.05；95% CI，1.00-1.10）、基线功能障碍以及年龄较大均与功能障碍相关。12个月后，124名患者的PVFS评分为1（0-2）。女性（OR，4.47；95% CI，2.11-16.00）、心血管/肺部疾病史（OR，2.36；95% CI，1.01-6.89）以及基线功能障碍与功能障碍相关。VTE患者的功能障碍在诊断后3和12个月有所改善，但未恢复到VTE前的水平。我们识别出一些临床特征，有助于预测VTE后持续功能障碍的患者。

Abstract

Venous thromboembolism (VTE) is associated with various long-term complications.We aimed to investigate the association of clinical characteristics at VTE diagnosis with functional limitations 3 and 12 months afterward.We conducted a prospective cohort study of VTE patients, excluding patients with cancer, pregnancy, and postpartum period. Functional limitations were assessed with the post-VTE functional status (PVFS) scale (range, 0-4) within 21 days of diagnosis, after 3 and 12 months (prospectively), and 1 month before diagnosis (retrospectively). Twelve-month follow-up was only performed in patients on anticoagulation. We fitted 2 proportional odds logistic regression models for the 3- and 12-month follow-ups and computed odds ratios (ORs) with 95% bootstrap percentile confidence intervals (CIs).We included 307 patients (42% female, median age 55.6 years) with a median (IQR) PVFS scale grade of 2 (2-3) at study inclusion and 0 (0-0) before diagnosis. After 3 months, PVFS scale grade in 269 patients was 1 (0-2). Female sex (OR, 2.15; 95% CI, 1.26-4.14), body mass index (OR per 1 kg/m2 increase, 1.05; 95% CI, 1.00-1.10), functional limitations at baseline, and older age were associated with functional limitations. After 12 months, PVFS scale grade in 124 patients was 1 (0-2). Female sex (OR, 4.47; 95% CI, 2.11-16.00), history of cardiovascular/pulmonary disease (OR, 2.36; 95% CI, 1.01-6.89), and functional limitations at baseline were associated with functional limitations.Functional limitations in VTE patients improved 3 and 12 months after diagnosis but did not return to pre-VTE values. We identified clinical characteristics that could help identify patients at risk of persisting functional limitations after VTE.