Age over 65 years and high levels of C-reactive protein are associated with the risk of preoperative deep vein thrombosis following closed distal femur fractures: a prospective cohort study

Abstract

Background In this study, we investigated the epidemiological characteristics and predictors of preoperative new-onset deep vein thrombosis (DVT) in adult patients with closed distal femur fractures (DFFs). Methods The study was designed as a prospective cohort trial at the Third Hospital of Hebei Medical University. From October 2018 to June 2020, a total of 160 patients with closed DFFs were enrolled to assess the location and prognosis of preoperative DVT. The patients were followed up for 2 months. Duplex ultrasonography (DUS) was used to diagnose patients with DVT. The patients were divided into two groups (DVT group and non-DVT group). The DVT was then classified into proximal, distal, and mixed thromboses. The Mann-Whitney U test or t test, receiver operating characteristic (ROC) analyses, univariate Chi-square analyses, and multiple logistic regression analyses were used to analyze the adjusted predictors of DVT. Results The overall incidence of preoperative DVTs was 52.5% (n = 84), which was diagnosed at a mean period of 3.1 days after injury. Among patients diagnosed with DVTs, 50.0% (n = 42) had distal thrombosis while 47.6% (n = 40) had mixed thrombosis. The calf muscle veins were the most common sites of DVTs (90.5%, n = 76). Of note, 45.2% (n = 38) of diagnosed DVTs were completely recanalized at a mean period of 12.0 days after the initial (first) diagnosis. Multivariate analysis revealed that age of ≥ 65 years of age (odds ratio [OR], 4.390; 95% confidence interval [CI] 1.727–11.155; p = 0.002), C-reactive protein (CRP) levels exceeding 11 mg/L (OR 4.158; 95% CI 1.808–11.289; p = 0.001), platelet (PLT) levels over 217 × 109/L (OR, 2.55; 95% CI 1.07–6.07; p = 0.035), D-dimer levels over 1.0 mg/L (OR 3.496; 95% CI 1.483–8.237; p = 0.004), and an American Society of Anesthesiologists (ASA) score of III-V (OR 2.753; 95% CI 1.216–6.729; p = 0.026) were the independent risk factors of preoperative DVT. Conclusions High levels of CRP, PLT, D-dimer, ASA, and ≥ 65 years of age increase the risk of preoperative DVTs in adult patients with closed DFFs. Thus, the prediction of preoperative DVTs can significantly be improved by identifying older patients over the age of 65, and establishing the biochemical cut-off values of CRP, PLT, ASA, and D-dimer. Trial registration No. 2018-026-1, 24 October 2018, prospectively registered. This trial was registered prospectively on 24 October 2018 before the first participant was enrolled. This study protocol conformed to the Declaration of Helsinki and approved by the Institutional Review Board. The ethics committee approved the study on the factors of prognosis for patients with fractures. Data used in this study were obtained from the patients who underwent orthopedic surgery between October 2018 and June 2020.

Analysis of high-risk factors for preoperative DVT in elderly patients with simple hip fractures and construction of a nomogram prediction model

“…Niu [ 25 ] found that the risk was 2.02 times greater in elderly patients with hip fracture with a preoperative PLT count> 220 × 10 9 /L compared to patients without DVT. Another study [ 26 ] also found that elderly patients with femoral fractures had a 2.55-fold risk of developing DVT before operation when PLT count> 217 × 10 9 /L. In this study, multiple logistic regression analysis showed that PLT count was one of the independent risk factors for DVT ( P < 0.05), with an AUC = 0.642 (95% CI: 0.569 ~ 0.714), cutoff value of 200.5 × 10 9 /L, OR = 1.008 (95% CI: 1.002 ~ 1.015), and sensitivity and specificity of 38.9 and 85.9%, respectively.…”

“…Another study stated that the sensitivity and specificity of the D-dimer level suggesting DVT were 71.4 and 78.6%, respectively, when the D-dimer level was>2.79 mg/L. [ 22 ] The optimal critical value of D-dimer was 1.0 mg/L, approximately twice the upper limit of the standard (0.5 mg/L) in patients with femoral fractures over 65 years old in a recent prospective study [ 26 ], and the risk of preoperative DVT increased by 3.5 when the D-dimer level was >1.0 mg/L. Therefore, appropriate adjustment of the cutoff value is necessary and valuable for the clinical judgment of perioperative complications of DVT in patients of different ages.…”

Prevalence and risk factors of preoperative deep venous thrombosis in closed patella fracture: a prospective cohort study

“…Park et al [ 25 ] reported that an advanced age above 60 years was a significant predictor of DVT in patients with fractures below the hip. In a prospective cohort study, Zhang et al [ 26 ] reported that age over 65 years was associated with the formation of preoperative DVT in distal femur fractures. Goel et al [ 27 ] found age > 40 years was an independent predictor for DVT following fractures below the knee.…”

Preoperative incidence and risk factors of deep venous thrombosis in patients with isolated femoral shaft fracture

“…Elsewhere, Zhang et al . prospectively studied 160 patients over 65 years of age with distal femoral fractures and found that the incidence of preoperative DVT detected by DUS was 52.5% (84/160) [ 18 ]. The results of the current study showed a low incidence of preoperative DVT (26.4%, 114/432).…”

“…Age is an important factor in the formation of DVT, especially in patients with trauma [ 10 , 18 , 20 ]. Among the 432 patients (aged 18–90 years) with femoral shaft fractures in the present study, it was evident that each additional 10 years of age was associated with a 20% increase in risk of preoperative DVT (P < 0.002).…”