Multifactor analysis of risk factors associated with deep venous thrombosis (DVT) in lower extremity after intertrochanteric fractures in the elderly

doi:10.3877/cma.j.issn.2096-0263.2020.03.002

Abstract

Abstract:

Objective

Deep venous thrombosis (DVT) of lower limbs is one of the most common complications in elderly patients with trauma. The purpose of this study was to investigate the incidence, location and related risk factors of deep venous thrombosis (DVT) of lower extremities after intertrochanteric fractures in the elderly.

Methods

A retrospective analysis was performed on the elderly intertrochanteric fracture patients admitted to Tianjin Nankai hospital and General Hospital of Hebei from January 2015 to June 2019. After admission, the patients were diagnosed with deep vein thrombosis (DVT) by routine ultrasound doppler scanning. Patients with DVT were assigned to the case group and those without DVT to the control group. Patient data were obtained from inpatient records, including demographic data, comorbidities, injury-related data, and inpatient laboratory test results. Univariate Chi-square or Student-t test was used to evaluate the difference between the two groups, and multivariate logistic regression analysis was used to determine the risk factors for DVT.

Results

A total of 673 patients were included in this study, and 125(18.6%) patients were diagnosed with DVT. Among them, 75(60.0%) were of the distal DVT, 37(29.6%) were proximal, and 13 (10.4%) were hybrid DVT. In 74.4% (93/125) of patients, DVT occurred in the fractured limb, 16.8% (11/125) in the bilateral limb, and 8.8% (21/125) in the non-fractured limb. Multivariate logistic regression analysis showed that from the time from injury to admission, increased D-dimer level (> 1.73mg/L) and RBC reduction (male, <4*10¹²/L; female, <3.5*10¹²/L), peripheral vascular history, overweight and obesity (with normal BMI as reference) were independent factors associated with DVT.

Conclusions

The incidence of admission DVT is high in the elderly patients with intertrochanteric fractures, with proximal DVT reaching 7.4%. Several associated risk factors are independently associated with DVT, and these epidemiological data are useful for predicting thrombogenesis, risk assessment, and targeted preoperative screening.

Key words: Hip fractures, Deep vein thrombosis, Epidemiology, Risk factors

Dawei Liu, Shuai Niu. Multifactor analysis of risk factors associated with deep venous thrombosis (DVT) in lower extremity after intertrochanteric fractures in the elderly[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2020, 06(03): 128-135.

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References 26

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变量		DVT组[125（18.6%）]	非DVT组[548（81.4%）]	统计值（χ²或t）	P值
性别（男性）		47（37.6）	207（37.8）	0.001	0.971
年龄（岁）		76.8±8.6	76.6±8.7	0.137	0.785
居住地				1.687	0.194
	农村	80（64.0）	316（57.7）
	城市	45（36.0）	232（42.3）
BMI（kg/m²）		24.6±4.1	23.5±3.3	7.186	0.002
18.5～23.9		51（40.8）	302（55.1）	12.858	0.005
<18.5		9（7.2）	31（5.7）
24.0～27.9		42（33.6）	165（30.1）
≥28.0		23（18.4）	50（9.1）
吸烟		18（14.4）	76（13.9）	0.024	0.877
糖尿病		31（24.8）	149（27.2）	0.297	0.586
高血压		74（59.2）	323（58.9）	0.003	0.958
脑血管病		44（35.2）	205（37.4）	0.213	0.644
心脏病		42（33.6）	179（32.7）	0.040	0.841
肺病史		3（2.4）	37（6.7）	3.448	0.086
肿瘤		4（3.2）	13（2.4）	0.283	0.595
肝病		4（3.2）	17（3.1）	0.003	0.955
肾病		4（3.2）	20（3.6）	0.060	0.807
类风湿及结缔组织病		0（0.0）	12（2.2）	2.787	0.095
周围血管病		10（8.0）	18（3.3）	5.676	0.017
过敏史		27（21.6）	124（22.6）	0.062	0.804
任意手术史		35（28.0）	160（29.2）	0.071	0.790
骨折分型（AO/OTA）				11.431	0.003
A1		19（14.1）	148（27.5）
A2		83（61.5）	296（55.0）
A3		33（24.4）	94（17.5）
受伤至入院间隔（d）		1.64±2.21	1.26±1.93	8.145	0.002
TP（<60 g/L）		84（67.2）	311（56.8）	4.583	0.032
ALB（<35 g/L）		89（71.2）	343（62.6）	3.282	0.070
LDH（>250 u/L）		39（31.2）	160（29.2）	0.196	0.658
TC（>5.2 mmol/L）		10（8.0）	37（6.8）	0.244	0.621
TG（>1.7 mmol/L）		6（4.8）	36（6.6）	0.545	0.461
HDL-C（<1.1 mmol/L）		62（49.6）	232（42.3）	2.183	0.140
Na+（<135 mmol/L）		32（25.6）	103（18.8）	2.939	0.086
FBG（>6.1 mmol/L）		80（64.0）	321（58.6）	1.243	0.265
NEU（>6.3*10⁹/L）		66（52.8）	288（54.8）	0.174	0.679
LYM（<1.1*10⁹/L）		62（49.6）	282（51.6）	0.141	0.693
RBC（<下限值）		94（75.2）	295（53.8）	19.053	<0.001
HGB（<下限值）		89（71.2）	312（56.9）	8.602	0.003
PLT（>350*10⁹/L）		14（11.2）	62（11.3）	0.001	0.971
PDW				0.706	0.703
	12～18.1%	113（90.4）	491（89.6）
	<12%	10（8.0）	41（7.5）
	>18.1%	2（1.6）	16（2.9）
D-二聚体（>0.3 mg/L）		108（86.4）	475（86.7）	0.007	0.934
D-二聚体（>0.5 mg/L）		102（81.6）	443（80.8）	0.038	0.845
D-二聚体（>1.73 mg/L）		69（55.2）	224（40.9）	8.495	0.004

变量		DVT组[125（18.6%）]	非DVT组[548（81.4%）]	统计值（χ²或t）	P值
性别（男性）		47（37.6）	207（37.8）	0.001	0.971
年龄（岁）		76.8±8.6	76.6±8.7	0.137	0.785
居住地				1.687	0.194
	农村	80（64.0）	316（57.7）
	城市	45（36.0）	232（42.3）
BMI（kg/m²）		24.6±4.1	23.5±3.3	7.186	0.002
18.5～23.9		51（40.8）	302（55.1）	12.858	0.005
<18.5		9（7.2）	31（5.7）
24.0～27.9		42（33.6）	165（30.1）
≥28.0		23（18.4）	50（9.1）
吸烟		18（14.4）	76（13.9）	0.024	0.877
糖尿病		31（24.8）	149（27.2）	0.297	0.586
高血压		74（59.2）	323（58.9）	0.003	0.958
脑血管病		44（35.2）	205（37.4）	0.213	0.644
心脏病		42（33.6）	179（32.7）	0.040	0.841
肺病史		3（2.4）	37（6.7）	3.448	0.086
肿瘤		4（3.2）	13（2.4）	0.283	0.595
肝病		4（3.2）	17（3.1）	0.003	0.955
肾病		4（3.2）	20（3.6）	0.060	0.807
类风湿及结缔组织病		0（0.0）	12（2.2）	2.787	0.095
周围血管病		10（8.0）	18（3.3）	5.676	0.017
过敏史		27（21.6）	124（22.6）	0.062	0.804
任意手术史		35（28.0）	160（29.2）	0.071	0.790
骨折分型（AO/OTA）				11.431	0.003
A1		19（14.1）	148（27.5）
A2		83（61.5）	296（55.0）
A3		33（24.4）	94（17.5）
受伤至入院间隔（d）		1.64±2.21	1.26±1.93	8.145	0.002
TP（<60 g/L）		84（67.2）	311（56.8）	4.583	0.032
ALB（<35 g/L）		89（71.2）	343（62.6）	3.282	0.070
LDH（>250 u/L）		39（31.2）	160（29.2）	0.196	0.658
TC（>5.2 mmol/L）		10（8.0）	37（6.8）	0.244	0.621
TG（>1.7 mmol/L）		6（4.8）	36（6.6）	0.545	0.461
HDL-C（<1.1 mmol/L）		62（49.6）	232（42.3）	2.183	0.140
Na+（<135 mmol/L）		32（25.6）	103（18.8）	2.939	0.086
FBG（>6.1 mmol/L）		80（64.0）	321（58.6）	1.243	0.265
NEU（>6.3*10⁹/L）		66（52.8）	288（54.8）	0.174	0.679
LYM（<1.1*10⁹/L）		62（49.6）	282（51.6）	0.141	0.693
RBC（<下限值）		94（75.2）	295（53.8）	19.053	<0.001
HGB（<下限值）		89（71.2）	312（56.9）	8.602	0.003
PLT（>350*10⁹/L）		14（11.2）	62（11.3）	0.001	0.971
PDW				0.706	0.703
	12～18.1%	113（90.4）	491（89.6）
	<12%	10（8.0）	41（7.5）
	>18.1%	2（1.6）	16（2.9）
D-二聚体（>0.3 mg/L）		108（86.4）	475（86.7）	0.007	0.934
D-二聚体（>0.5 mg/L）		102（81.6）	443（80.8）	0.038	0.845
D-二聚体（>1.73 mg/L）		69（55.2）	224（40.9）	8.495	0.004

变量	系数（B）	S.E	Wald	OR和95% CI	P值
周围血管病史	0.993	0.433	5.257	2.70（1.16-6.31）	0.022
慢性肺病史	1.045	0.625	2.795	2.84（0.84-9.68）	0.095
BMI（kg/m²）
18.5～23.9	参考	参考	参考	参考
<18.5	0.449	0.419	1.149	1.57（0.69-3.56）	0.284
24.0～27.9	0.477	0.238	4.033	1.61（1.01-2.57）	0.045
≥28.0	1.122	0.308	13.297	3.07（1.68-5.61）	<0.001
受伤至入院时间（d）	0.501	0.228	2.029	1.65（1.16-3.33）	0.007
*RBC计数减少	1.102	0.612	3.284	2.95（1.68-4.17）	<0.001
D-二聚体>1.73 mg/L	0.611	0.208	8.621	1.84（1.23-2.77）	0.003

变量	系数（B）	S.E	Wald	OR和95% CI	P值
周围血管病史	0.993	0.433	5.257	2.70（1.16-6.31）	0.022
慢性肺病史	1.045	0.625	2.795	2.84（0.84-9.68）	0.095
BMI（kg/m²）
18.5～23.9	参考	参考	参考	参考
<18.5	0.449	0.419	1.149	1.57（0.69-3.56）	0.284
24.0～27.9	0.477	0.238	4.033	1.61（1.01-2.57）	0.045
≥28.0	1.122	0.308	13.297	3.07（1.68-5.61）	<0.001
受伤至入院时间（d）	0.501	0.228	2.029	1.65（1.16-3.33）	0.007
*RBC计数减少	1.102	0.612	3.284	2.95（1.68-4.17）	<0.001
D-二聚体>1.73 mg/L	0.611	0.208	8.621	1.84（1.23-2.77）	0.003

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