Novel risk prediction models, involving coagulation, thromboelastography, stress response, and immune function indicators, for deep vein thrombosis after radical resection of cervical cancer and ovarian cancer

Figures & data

Table 1. Comparison of patients’ general clinical indicators and surgery-related indicators. (Data were represented as the Mean ± standard deviation (SD) or median [interquartile range, (IQR)] or percentage).

	Testing cohort (n = 374)		Verification cohort (n = 86)
Indicators	Cervical cancer (n = 187)	Ovarian cancer (n = 187)	Cervical cancer (n = 43)	Ovarian cancer (n = 43)
Age	59 (48-76)	56 (43-79)	55 (45-74)	58 (51-75)
BMI (kg/m^2)	24.65 ± 0.90	23.99 ± 1.04	24.51 ± 1.20	24.01 ± 1.14
Hypertension (n, %)	23 (12.30)	15 (8.02)	5 (11.63)	6 (13.95)
Operation time (min)	188.61 ± 26.53	195.90 ± 25.14	204.42 ± 19.20	186.69 ± 28.61
Intraoperative blood loss (ml)	189.44 ± 25.64	196.12 ± 30.82	183.72 ± 29.01	198.58 ± 13.52
Postoperative hospital stays (d)	8.71 ± 1.21	9.14 ± 1.40	8.82 ± 1.53	9.40 ± 1.76

Figure 1. The technical route of this study.

Table 2. Comparison of changes of thromboelastography, coagulation, stress response, and immune function indicators at different time points before and after operation in the testing cohort (n = 374). (Data were represented as the Mean ± standard deviation (SD)).

	Cervical cancer(n = 187)			Ovarian cancer(n = 187)
Indicators	Preoperative	1 day after operation	3 days after operation	Preoperative	1 day after operation	3 days after operation
Thromboelastography
MA (mm)	65.08 ± 5.08	74.52 ± 6.22^a	69.84 ± 6.02^a^,^b	64.09 ± 6.12	70.74 ± 7.66^a	77.94 ± 6.47^a^,b
K value (min)	1.73 ± 0.47	1.08 ± 0.26^a	1.39 ± 0.38^a^,^b	1.58 ± 0.47	1.29 ± 0.41^a	1.04 ± 0.18^a^,b
R-value (min)	5.89 ± 1.09	4.76 ± 0.86^a	5.28 ± 1.05^a^,^b	5.71 ± 1.33	5.27 ± 1.06^a	4.86 ± 0.53^a^,b
α angle (degree)	62.02 ± 4.93	76.07 ± 5.56^a	72.06 ± 5.26^a^,^b	62.06 ± 4.56	69.76 ± 5.98^a	75.25 ± 3.76^a^,b
Coagulation
PT (s)	13.83 ± 1.15	13.85 ± 0.88	13.86 ± 1.04	12.46 ± 1.01	12.50 ± 1.03	12.51 ± 0.93
APTT (s)	33.10 ± 3.57	28.86 ± 3.06^a	29.28 ± 3.56^a^,^b	32.14 ± 3.12	28.34 ± 3.08^a	29.86 ± 4.00^a^,b
INR	1.00 ± 0.08	1.02 ± 0.04	1.01 ± 0.05	1.03 ± 0.10	1.02 ± 0.09	1.02 ± 0.07
FIB (g/L)	2.85 ± 0.35	4.59 ± 0.56^a	3.96 ± 0.33^a^,^b	2.77 ± 0.37	3.45 ± 0.38^a	4.35 ± 0.44^a^,b
D-D (mg/L)	0.16 ± 0.04	0.77 ± 0.25^a	0.43 ± 0.12^a^,^b	0.13 ± 0.04	0.31 ± 0.04^a	0.29 ± 0.08^a
Stress response
CRP (ng/mL)	12.56 ± 2.35	36.16 ± 6.11^a	33.35 ± 5.67^a^,^b	11.54 ± 1.89	18.47 ± 4.53^a	35.71 ± 6.57^a^,b
SOD (U/mL)	88.78 ± 10.45	62.36 ± 5.59^a	73.44 ± 9.46^a^,^b	88.25 ± 9.67	73.14 ± 9.22^a	69.16 ± 7.86^a^,b
IL-6 (pg/mL)	8.35 ± 1.18	36.08 ± 6.47^a	23.11 ± 5.44^a^,^b	8.50 ± 1.14	19.76 ± 5.25^a	23.11 ± 8.54^a^,b
Immune function
CD4^+/CD8^+	1.50 ± 0.17	1.30 ± 0.13^a	1.36 ± 0.14^a^,^b	1.54 ± 0.13	1.56 ± 0.10	1.30 ± 0.14^a^,b

Abbreviation: R-value: reaction time value; MA: maximum amplitude value; PT: prothrombin time; APTT: activated partial thromboplastin time; FIB: fibrinogen; D-D: D-dimerization; IL-6: interleukin 6; SOD: superoxide dismutase; CRP: C-reactive protein.

^aCompared with the preoperative group, p < 0.05.

^bCompared with the group one day after operation, p < 0.05.

Table 3. The calculated performance values for different indicators in the testing cohort.

Variable	AUC	95% CI	p	Sensitivity (%)	Specificity (%)
Cervical cancer
R-value (min), 1 day after operation	0.835	0.798–0.873	<0.001	69.0	100.0
K value (min), 1 day after operation	0.792	0.751–0.832	<0.001	77.4	68.4
α angle (degree), 1 day after operation	0.917	0.891–0.945	<0.001	93.8	78.2
MA (mm), 1 day after operation	0.843	0.805–0.882	<0.001	90.3	62.5
FIB (g/L), 1 day after operation	0.797	0.754–0.841	<0.001	73.8	86.6
D-D (mg/L), 1 day after operation	0.773	0.726–0.822	<0.001	70.9	90.4
IL-6 (pg/mL), 1 day after operation	0.715	0.666–0.764	<0.001	58.3	92.1
SOD (U/mL), 1 day after operation	0.747	0.703–0.795	<0.001	68.8	78.6
Model for cervical cancer	0.934	0.910–0.961	<0.001	87.9	100.0
Ovarian cancer
R-value (min), 3 days after operation	0.807	0.765–0.849	<0.001	68.2	100.0
K value (min), 3 days after operation	0.877	0.845–0.909	<0.001	78.3	85.2
α angle (degree), 3 days after operation	0.867	0.834–0.900	<0.001	76.9	85.4
MA (mm), 3 days after operation	0.710	0.662–0.757	<0.001	52.3	100.0
CRP (ng/mL), 3 days after operation	0.833	0.794–0.872	<0.001	72.1	100.0
FIB (g/L), 3 days after operation	0.787	0.743–0.831	<0.001	73.2	84.3
CD4^+/CD8^+, 3 days after operation	0.826	0.788–0.863	<0.001	68.6	92.2
Model for ovarian cancer	0.941	0.917–0.964	<0.001	87.4	100.0

Abbreviation: R-value: reaction time value; MA: maximum amplitude value; PT: prothrombin time; FIB: fibrinogen; D-D: D-dimerization; SOD: superoxide dismutase; AUC: area under curve; OR: odd ratio; CI: confidence interval.

Figure 2. ROC analysis of coagulation, thromboelastography, stress response, and immune function laboratory indicators to predict the occurrence of DVT after radical resection of cervical cancer and ovarian cancer in the testing cohort. (A) Radical resection of cervical cancer (n = 187). (B) Radical resection of ovarian cancer (n = 187). ROC: receiver operator characteristic; DVT: deep venous thrombosis.

Figure 3. Validation of the logistic regression models in the validation cohort. (A) Comparison of the incidence of DVT between the group of estimated probability ≥0.806 and the group of estimated probability <0.806 in the radical resection of cervical cancer group. (B) Comparison of the incidence of DVT between the group of estimated probability ≥0.697 and the group of estimated probability <0.697 in the radical resection of ovarian cancer group. DVT: deep venous thrombosis.

Data availability statement

Data available within the article.