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Risk Prediction and Treatment of LE-DVT in Patients with Chronic Radiation Intestinal Injury: A Retrospective Case–Control Study
Cancer Management and Research ( IF 3.3 ) Pub Date : 2021-08-23 , DOI: 10.2147/cmar.s319918
Xiaoyan Huang 1, 2, 3 , Yingyi Kuang 1, 2, 3 , Qiyuan Qin 1, 2, 3 , Miaomiao Zhu 1, 2, 3 , Yanjiong He 1, 2, 3 , Zixu Yuan 1, 2, 3 , Huaiming Wang 1, 2, 3 , Qinghua Zhong 1, 2, 4 , Qi Guan 1, 2, 3 , Hui Wang 1, 2, 3 , Tenghui Ma 1, 2, 3 , Xinjuan Fan 1, 2, 5
Affiliation  

Background: Chronic radiation intestinal injury (CRII) is the most common complication after pelvic malignancy radiation. Once hemorrhagic CRII patients suffer from lower extremity deep venous thrombosis (LE-DVT), hemostasis and anticoagulation therapy will be adopted simultaneously, but the treatment strategy is a paradox, as the condition is extremely intractable and serious. The aim of this study was to investigate the prevalence of and risk factors for LE-DVT in CRII patients and explore the treatment of hemorrhagic CRII patients with LE-DVT.
Methods: This was a retrospective study, and a total of 608 hospitalized CRII patients after pelvic radiotherapy were included from November 2011 to October 2018. Univariate and multivariate analyses were conducted to investigate the potential risk factors for LE-DVT in CRII patients. Furthermore, the treatment of hemorrhagic CRII patients with LE-DVT was explored.
Results: Among the CRII patients, 94 (15.5%) were with suspicious symptoms of LE-DVT in the lower limbs, and 32 (5.3%) were diagnosed with LE-DVT. Among the patients with LE-DVT, 65.6% (21/32) had bleeding simultaneously, and 29 (90.6%) had anemia with 24 (75.0%) having moderate to severe anemia. Multivariate analysis showed that a recent surgical history (≤ 6 months) (OR = 5.761, 95% CI: 2.506∼ 13.246, p < 0.001), tumor recurrence or metastasis (OR = 3.049, 95% CI: 1.398∼ 6.648, p = 0.005) and the hemoglobin (Hb) level (OR = 0.960, 95% CI: 0.942∼ 0.979, p < 0.001) were significantly associated with the development of LE-DVT. ROC curve analysis showed that the AUC of the merged risk score of the independent risk factors was 0.822 (95% CI: 0.789∼ 0.852), and the optimal Hb cutoff was 82.5 g/L. After colostomy, obvious bleeding remission was rapidly found in 84.6% of hemorrhagic CRII patients with LE-DVT.
Conclusion: The prevalence of LE-DVT in hospitalized CRII patients was 5.3%. A recent surgical history, tumor recurrence or metastasis and a lower Hb level were independently associated with LE-DVT development in CRII patients. Colostomy could be a good choice for intractable hemorrhagic CRII patients with LE-DVT.



中文翻译:

慢性放射性肠损伤患者 LE-DVT 的风险预测和治疗:回顾性病例对照研究

背景:慢性放射性肠损伤(CRII)是盆腔恶性肿瘤放疗后最常见的并发症。出血性CRII患者一旦出现下肢深静脉血栓形成(LE-DVT),止血和抗凝治疗会同时进行,但治疗策略是矛盾的,病情极其棘手和严重。本研究的目的是调查 CRII 患者 LE-DVT 的患病率和危险因素,并探讨 LE-DVT 对出血性 CRII 患者的治疗。
方法:这是一项回顾性研究,共纳入 2011 年 11 月至 2018 年 10 月接受盆腔放疗后住院的 608 例 CRII 患者。通过单因素和多因素分析,调查 CRII 患者发生 LE-DVT 的潜在危险因素。此外,探索了 LE-DVT 出血性 CRII 患者的治疗。
结果:在CRII患者中,94例(15.5%)有可疑下肢LE-DVT症状,32例(5.3%)确诊为LE-DVT。LE-DVT患者中,65.6%(21/32)同时出血,29例(90.6%)贫血,24例(75.0%)中度至重度贫血。多变量分析显示,近期手术史(≤ 6 个月)(OR = 5.761, 95% CI: 2.506∼13.246, p< 0.001)、肿瘤复发或转移 (OR = 3.049, 95% CI: 1.398∼6.648, p = 0.005) 和血红蛋白 (Hb) 水平 (OR = 0.960, 95% CI: 0.942∼0.979, p < 0.001)与 LE-DVT 的发展显着相关。ROC曲线分析显示,独立危险因素合并风险评分的AUC为0.822(95% CI:0.789~0.852),最佳Hb截止值为82.5 g/L。结肠造口术后 84.6% 的 LE-DVT 出血性 CRII 患者出血明显缓解。
结论:住院 CRII 患者中 LE-DVT 的患病率为 5.3%。最近的手术史、肿瘤复发或转移以及较低的 Hb 水平与 CRII 患者的 LE-DVT 发展独立相关。对于伴有 LE-DVT 的顽固性出血性 CRII 患者,结肠造口术可能是一个不错的选择。

更新日期:2021-08-23
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