Abstract
BackgroundDeep venous thrombosis (DVT) of the lower extremities is one of the common complications for neurointensive care unit patients, which leads to increased morbidity and mortality. The purpose of our study was to explore risk factors and develop a prognostic nomogram for lower extremity DVT in neurointensive care unit patients.MethodsWe prospectively collected and analyzed the clinical data of 420 neurointensive care unit patients who received treatment in our institution between January 2018 and September 2019. Stepwise logistic regression was used to select predictors. R software was used to develop the prognostic nomogram. The performance of the nomogram was validated using a validation cohort of patients with data collected between October 2019 and March 2020.ResultsAmong 420 patients, 153 (36.4%) had lower extremity DVT and five (1.2%) had both DVT and pulmonary embolism (PE) in our study. Logistic regression analysis indicated that age [odds ratio (OR): 1.050; 95% confidence interval (CI): 1.029–1.071; P < 0.001], Glasgow Coma Scale (GCS) score (OR: 0.889; 95% CI: 0.825–0.959; P = 0.002), D-dimer level (OR: 1.040; 95% CI: 1.008–1.074; P = 0.014), muscle strength (OR: 2.424; 95% CI: 1.346–4.366; P = 0.003), and infection (OR: 1.778; 95% CI: 1.034–3.055; P = 0.037) were independent predictors for lower extremity DVT. These predictors were selected to be included in the nomogram model. The area under the curve values in the primary cohort and validation cohort were 0.817 (95% CI: 0.776–0.858) and 0.778 (95% CI: 0.688–0.868), respectively, and respective Brier scores were 0.167 and 0.183.ConclusionAge, GCS score, D-dimer level, muscle strength, and infection are independent predictors for lower extremity DVT. The nomogram is a reliable and convenient model to predict the development of lower extremity DVT in neurointensive care unit patients.
Highlights
Patients admitted to the neurointensive care unit are at a high risk for lower extremity deep vein thrombosis (DVT) due to factors such as disturbance of consciousness, craniotomy, paralysis, and maintaining a long-term bedridden state [1,2,3,4]
This study found that in our neurointensive care unit patient cohort, the incidence of lower extremity DVT was 36.4%, which was higher than the incidence in patients after neurosurgery who are not admitted to the neurointensive care unit reported by other studies [1, 3]
This study revealed that the Glasgow Coma Scale (GCS) scores of the patients who developed lower extremity DVT were significantly lower than those who did not develop lower extremity DVT (P < 0.001)
Summary
Patients admitted to the neurointensive care unit are at a high risk for lower extremity deep vein thrombosis (DVT) due to factors such as disturbance of consciousness, craniotomy, paralysis, and maintaining a long-term bedridden state [1,2,3,4]. The nomogram model can integrate relevant risk factors and individually predict the risk of adverse clinical events. Despite the risks of DVT and subsequent PE, there is still no nomogram model to predict the occurrence of lower extremity DVT in neurointensive care units. In this prospective study, we focused on neurointensive care unit patients and established a reliable prognostic nomogram for providing a reference to identify the patients at high-risk of developing lower extremity DVT early. The purpose of our study was to explore risk factors and develop a prognostic nomogram for lower extremity DVT in neurointensive care unit patients
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