Comparison between the Khorana prediction score and Caprini risk assessment models for assessing the risk of venous thromboembolism in hospitalized patients with cancer: a retrospective case control study.

OBJECTIVES: This study aimed to evaluate the optimal risk assessment model (RAM) to stratify the risk of venous thromboembolism (VTE) in hospitalized patients with cancer. We examined and compared the VTE predictive ability of the Khorana score (KS) and the Caprini RAM in hospitalized cancer patients. METHODS: We performed a retrospective case-control study among hospitalized cancer patients admitted to a comprehensive hospital in China from January 2015 to December 2016. A total of 221 cases were confirmed to have VTE during hospitalization and 221 controls were selected randomly. The Caprini RAM and KS were implemented and the individual scores of each risk factor were summed to generate a cumulative risk score. Meanwhile, the sensitivity, specificity, areas under curve of the receiver operating characteristic curve and calibration of these 2 models were analysed. RESULTS: Significant differences were observed in risk factors between VTE and non-VTE hospitalized cancer patients and the VTE risk increased significantly with an increase in the cumulative KS or Caprini RAM score. A classification of 'high risk' according to KS and Caprini RAM was associated with 2.272-fold and 3.825-fold increases in VTE risk, respectively. However, the Caprini RAM could identify 82.4% of the VTE cases that required preventive anticoagulant therapy according to American College of Chest Physicians guidelines, whereas the KS could only identify 35.3% of the VTE cases. In addition, the areas under curve of Caprini RAM were significantly higher than those of the KS (0.705 ± 0.024 vs 0.581 ± 0.025, P < 0.001), with a best cut-off value of 5 score, which happened to be the cut-off value for high risk of VTE in Caprini RAM. Both Caprini RAM and KS showed an excellent calibration curve (0.612 vs 0.141, P > 0.05), but the risk of VTE events predicted by Caprini seemed closer to the observed risk of VTE events. CONCLUSIONS: The Caprini RAM was found to be more effective than the KS in identifying hospitalized patients with cancer at risk of VTE.

[Impact of chronic obstructive pulmonary disease on quality of life and economic burden in Chinese urban areas].

OBJECTIVE: To assess the impact of chronic obstructive pulmonary disease (COPD) on the quality of life and economic burden in Chinese urban areas. METHODS: COPD patients (n = 723) were interviewed face-to-face in outpatient departments in 6 large cities in China. The questionnaire included social and demographic information, current health status, quality of life (SGRQ), and medical expenditure on outpatient visit, hospitalization, medicine purchasing in medicine stores in the last 12 months, and other expenditures related with COPD were also collected. All the data were analyzed using descriptive method. RESULTS: Of the 723 COPD patients interviewed, 73% were male and the average age was 67 years old. The average symptom score of SGRQ was 49 +/- 24, activity score 57 +/- 23, impact score 46 +/- 23 and total score 50 +/- 21, which were all higher than scores of the healthy populations. The average direct medical cost (including outpatient cost, inpatient cost, and medicine purchasing cost) was 11 744 RMB yuan annually. The direct non-medical cost (including transportation fee, nutrition fee, and nursing fee) was 1570 RMB yuan. 36% of the patients in work had an average of 17 working days lost in the last 12 months because of COPD, while 17% of their relatives had an average of 14 working days lost for caring the patients. CONCLUSIONS: COPD has a serious impact on the quality of life of Chinese urban patients and places a heavy economic burden on their family and the society. Management of COPD should be improved for patients at stable conditions, so as to reduce the incidence and exacerbation of COPD.

Predictors of health-related quality of life in patients with obstructive sleep apnoea.

AIM: This paper is a report of a study to identify the common symptoms and demographic and physiological factors of obstructive sleep apnoea that are predictive of health-related quality of life in a Chinese population. BACKGROUND: Health-related quality of life impairment in obstructive sleep apnoea is an increasingly important consideration, but little is known about the factors that influence quality of life in this population. METHOD: A total of 108 Chinese patients with newly diagnosed obstructive sleep apnoea were recruited in 2003 and assessed for health-related quality of life, daytime sleepiness, depression and anxiety. Associations between symptoms, demographic and physiological factors and quality of life were examined by Pearson linear correlation. Hierarchical multiple regression were used to determine predictors of overall quality of life and its dimensions. RESULTS: Forty-six patients (42.6%) had depressed mood and 21 (19.4%) were anxious. Fifty-nine (54.6%) were hypersomnolent. The severity of symptoms of sleepiness, depression, and anxiety was statistically significantly inversely correlated with each domain and the total score for health-related quality of life. No statistically significant correlation was observed between disease severity and quality of life. Controlling for age and gender, anxiety and sleepiness predicted 45.2% of the variance of overall quality of life (R(2) = 0.452, P < 0.001). Anxiety was the strongest predictor of overall and each domain of health-related quality of life. CONCLUSION: Assessment of mood in patients with obstructive sleep apnoea should be an essential part of nursing practice. Comprehensive evaluation of symptoms, especially mood disturbance, is important for improving quality of life for these patients.