Development of a predictive model for deep vein thrombosis in burn patients based on the Caprini Risk Assessment Scale.

Am J Transl Res 2025;17(1):538-549 www.ajtr.org /ISSN:1943-8141/AJTR0161293 Original Article Development of a predictive model for deep vein thrombosis in burn patients based on the Caprini Risk Assessment Scale Lanzhen Xie1, Aihua Xu1, Dandan Cai2, Jizhong Ma1 Burn Department, Jinhua Central Hospital in Zhejiang Province, Jinhua 321000, Zhejiang, China; 2Neurosurgery Department, Jinhua Central Hospital in Zhejiang Province, Jinhua 321000, Zhejiang, China 1 Received October 18, 2024; Accepted December 27, 2024; Epub January 15, 2025; Published January 30, 2025 Abstract: Objective: To explore the applicability of the Caprini Risk Assessment Scale in burn patients for evaluating the risk of deep vein thrombosis (DVT). Methods: A retrospective case-control study was conducted involving 278 burn patients from March 2021 to March 2023, with an additional independent test set of 119 patients for external validation. Patients were stratified into DVT and non-DVT groups based on the DVT incidence within one month after burn. The Caprini Risk Assessment Scale was employed to calculate scores and determine risk factors. Multivariate logistic regression analyses identified significant risk factors, and receiver operating characteristic (ROC) curves evaluated the model’s predictive power. Results: The mean Caprini score was significantly higher in the DVT group (6.61 ± 2.64) compared to the non-DVT group (4.89 ± 2.36; P < 0.001). Key risk factors included older age, increased body mass index (BMI), and a personal or family history of thrombosis. DVT patients were more prone to higher Caprini scores and classified as ‘very high risk’. Logistic regression demonstrated a positive correlation between Caprini scores, risk stratification, and DVT incidence (β = 0.284, OR = 1.329; β = 0.466, OR = 1.594, respectively). The predictive model displayed strong discriminatory power, with an area under the curve (AUC) of 0.853 in the training set and 0.937 in the test set. Conclusion: The Caprini Risk Assessment Scale is an effective tool for predicting DVT risk in burn patients, aiding in risk stratification and targeted prophylaxis. Keywords: Deep vein thrombosis, Caprini Risk Assessment Scale, burn patients, venous thromboembolism, risk stratification, predictive model Introduction Deep vein thrombosis (DVT) is a significant and potentially life-threatening complication in burn patients, leading to prolonged hospital stays, increased healthcare costs, and, in severe cases, pulmonary embolism [1-3]. The pathophysiology of thromboembolism in burn patients is complex, involving systemic inflammatory responses, increased coagulation factor levels, and immobilization, all contributing to a hypercoagulable state [4, 5]. Despite advancements in burn care and thromboembolic prophylaxis, the incidence of DVT in burn patients remains substantial, necessitating effective risk assessment tools to stratify patients and guide prophylactic strategy efficiently [6]. The Caprini Risk Assessment Scale is widely used for evaluating venous thromboembolism (VTE) risk, both in surgical and non-surgical patients [7]. The scale incorporates a comprehensive array of risk factors, including age, body mass index (BMI), personal and family history of thrombosis, and immobilization, assigning weighted scores to each factor. The aggregate score classifies patients’ risk levels from low to very high. While the scale has proven its efficacy across various medical domains, its application in specialized populations, such as burn patients, remains underexplored. Previous studies on DVT in burn patients have primarily focused on identifying individual risk factors or evaluating the efficacy of various prophylactic measures [6, 8-10]. However, few have sought to create comprehensive predictive models tailored to this group. The primary aim of this study was to validate the applicability of the Caprini Risk Assessment Scale for https://doi.org/10.62347/EBEW2103 DVT prediction in burn patients developing a predictive model for DVT in burn patients, thereby refining the scale’s utility and extending its clinical applicability. Materials and methods DVT group (n = 176). In addition, 119 patients who met the same inclusion and grouping criteria were included in the external test set, further divided into a DVT group (n = 52) and a non-DVT group (n = 67). Case selection Caprini Risk Assessment Scale In this retrospective case-control study, we included 278 burn patients admitted to Jinhua Central Hospital in Zhejiang Province from March 2021 to March 2023. Additionally, 119 patients were included in an independent test set for external validation, selected based on the same inclusion and exclusion criteria and grouping requirements. Patient information, including demographic data, baseline characteristics, Caprini risk score, and risk stratification, was collected from the hospital’s case management system. The Caprini Risk Assessment Scale was employed to evaluate and categorize the DVT risk for patients in both groups. This scale comprises roughly 40 risk factors, each assigned a score ranging from 1 to 5 points according to its severity. Based on the aggregate score, DVT risk was classified into four levels: low risk (≤ 1 point), moderate risk (2 points), high risk (3-4 points), and very high risk (≥ 5 points). The detailed scoring criteria are presented in Table 1. The study was approved by the Institutional Review Board and Ethics Committee of Jinhua Central Hospital in Zhejiang Province, adhering to the principles outlined in the Declaration of Helsinki. Informed consent was waived due to the retrospective nature of the study and the exclusive use of de-identified patient data, which posed no potential harm to patients. Inclusion, exclusion, and grouping criteria Inclusion criteria: 1) Participants aged over 18 years of age, with no history of mental illness; 2) Patients with normal cognitive function, and the ability to cooperate with various treatments and examinations; 3) Patients met the diagnostic criteria for burn injury [11]; 4) Patients with complete clinical data. Exclusion Criteria: 1) Severe compound injuries, such as asphyxia, fractures; 2) Previous treatment at another hospital or request transfer during the course of treatment; 3) Severe underlying diseases, such as liver or kidney dysfunction, or primary hematological disorders; 4) Malignant tumors or autoimmune diseases; 5) High risk of bleeding, rendering the patient unable to tolerate anticoagulant or antiplatelet therapy, such as peptic ulcers or recent major surgery. According to whether the patients developed DVT within 1 month after burn injury, they were divided into a DVT group (n = 102) and a non- 539 The weightings for the risk factors were determined through a combination of expert consensus and empirical data from previous studies. For example, the weight assigned to age (≥ 70 years) was 3 points, reflecting its strong association wit (...truncated)