A Prediction Model Based on Blood Biomarker for Mortality Risk in Patients with Acute Venous Thromboembolism

Figures & data

Table 1 Clinical Baseline Characteristics in Training Set and Validation Set

	Total (n=700)	Training Set (n=489)	Validation Set (n=211)	P value
Gender				0.376
Male	313 (45%)	224 (46%)	89 (42%)
Female	387 (55%)	265 (54%)	122 (58%)
Age (years)	60 (49, 68)	60 (49, 68)	57 (48, 66)	0.890
Interval time* (days)	7 (3, 10)	7 (3, 10)	7 (4, 10)	0.950
Hospitalization duration (days)	14 (10, 15)	14 (10, 15)	14 (11, 15)	0.440
Smoke	198 (28%)	143 (29%)	55 (26%)	0.392
Alcohol	181 (26%)	130 (27%)	51 (24%)	0.503
Comorbidity
Hypertension	223 (32%)	172 (35%)	51 (24%)	0.004
Diabetes mellitus	58 (8%)	40 (8%)	18 (9%)	0.877
Cerebral disease	67 (10%)	54 (11%)	13 (6%)	0.044
Coronary heart disease	121 (17%)	85 (17%)	36 (17%)	0.918
Pulmonary disease	48 (7%)	35 (7%)	13 (6%)	0.632
Fracture	59 (8%)	42 (9%)	17 (9%)	0.816
Immune rheumatic disease	42 (6%)	29 (6%)	13 (6%)	0.906
Peripheral vascular disease	65 (9%)	49 (10%)	16 (8%)	0.308
Surgery within last three months	175 (25%)	113 (23%)	62 (29%)	0.078
Venous thromboembolism				0.384
DVT	364(52%)	249 (51%)	115 (55%)
DVT+PE	336 (48%)	240 (49%)	96 (45%)
Thrombus location in limbs				0.578
Ilio-femoral vein	427 (61%)	295 (60%)	132 (63%)
Popliteal vein and calf vein only	273 (39%)	294 (40%)	79 (37%)
Main blood examination
White cell count (10^9/L)	7.15 (5.77, 9.15)	7.26 (5.71, 9.18)	6.95 (5.87, 9.11)	0.826
Neutrophil count (10^9/L)	5.09 (3.76, 6.82)	5.11 (3.71, 6.82)	5.08 (3.81, 6.82)	0.776
Lymphocyte count (10^9/L)	1.42 (1.13, 1.79)	1.40 (1.11, 1.80)	1.45 (1.16, 1.76)	0.978
Platelet count (10^9/L)	218 (174, 272)	216 (173, 273)	224 (174, 269)	0.974
D-Dimer (ug/mL)	3.01 (1.09, 6.05)	2.99 (1.08, 5.56)	3.25 (1.12, 6.53)	0.160
NLR	3.50 (2.37, 5.16)	3.54 (2.37, 5.27)	3.46 (2.37, 5.09)	0.448
PLR	150.48 (112.48, 205.61)	150 (111.42, 210.63)	151.53 (114.01, 196.15)	0.138
SII	738.96 (484.92, 1175.05)	753.37 (486.73, 1183.64)	705.50 (476.59, 1145.04)	0.293

Notes: Data are presented as counts with percentages n(%) or median with interquartile range (median [Q1, Q3]). Interval time*: days from VTE onset to admission to hospital.

Abbreviations: DVT, deep venous thrombosis; PE, pulmonary embolism; NLR, neutrophil/lymphocyte ratio; PLR, platelet/lymphocyte ratio; ROC, receiver operating characteristic curve.

Table 2 Clinical Baseline Characteristics and Univariate Analyses Between Survivor and Death in Training Set

	Total (n=490)	Survivor (n=437)	Death (n=52)	P value
Gender				0.521
Male	224 (46%)	198 (45%)	26 (50%)
Female	265 (54%)	239 (55%)	26 (50%)
Age (years)	60 (49, 68)	60 (47, 67)	70 (61, 77)	<0.001
Interval time* (days)	7 (3, 10)	7 (3, 10)	7 (4, 19)	0.116
Hospitalization duration (days)	14 (10, 15)	14 (10, 15)	12 (9, 15)	0.254
Smoke	143 (29%)	129 (30%)	14 (27%)	0.697
Alcohol	130 (27%)	117 (27%)	13 (25%)	0.784
Comorbidity
Hypertension	172 (35%)	148 (34%)	24 (46%)	0.079
Diabetes mellitus	40 (8%)	30 (7%)	10 (19%)	0.002
Cerebral disease	54 (11%)	39 (9%)	15 (29%)	<0.001
Coronary heart disease	85 (17%)	69 (16%)	16 (31%)	0.007
Pulmonary disease	35 (7%)	27 (6%)	8 (15%)	0.015
Fracture	42 (9%)	35 (8%)	7 (13%)	0.185
Immune rheumatic disease	29 (6%)	27 (6%)	2 (4%)	0.501
Peripheral vascular disease	49 (10%)	46 (11%)	3 (6%)	0.280
Surgery within last three months	113 (23%)	104 (24%)	9 (17%)	0.294
Venous thromboembolism				0.189
DVT	249 (51%)	227 (52%)	22 (42%)
DVT+PE	240 (49%)	210 (48%)	30 (58%)
Thrombus location in limbs				0.312
Ilio-femoral vein	295 (60%)	267 (61%)	28 (54%)
Popliteal vein and calf vein only	194 (40%)	170 (39%)	24 (46%)
Main blood examination
White cell count (10^9/L)	7.26 (5.71, 9.18)	7.20 (5.67, 9.14)	7.43 (6.37, 10.04)	0.102
Neutrophil count (10^9/L)	5.11 (3.71, 6.82)	5.05 (3.69, 6.82)	5.60 (4.09, 7.21)	0.091
Lymphocyte count (10^9/L)	1.40 (1.11, 1.80)	1.43 (1.12, 1.81)	1.23 (1.01, 1.60)	0.095
Platelet count (10^9/L)	216 (173, 273)	216 (174, 273)	215 (167, 281)	0.871
D-Dimer (ug/mL)	2.99 (1.08, 5.56)	2.93 (1.07, 5.98)	3.02 (1.11, 5.20)	0.155
NLR	3.54 (2.37, 5.27)	3.47 (2.35, 5.07)	4.76 (2.53, 7.31)	0.040
PLR	150 (111.42, 210.63)	150 (110.30, 207.27)	152 (126.39, 225.01)	0.093
SII	753.37 (486.73, 1183.64)	730.35 (477.56, 1165.42)	923.75 (569.24, 1524.29)	0.081

Notes: Data are presented as counts with percentages n(%) or median with interquartile range (median [Q1, Q3]). Interval time*: days from VTE onset to admission to hospital. DVT, deep venous thrombosis; PE, pulmonary embolism; NLR, neutrophil/lymphocyte ratio; PLR, platelet/lymphocyte ratio; ROC, receiver operating characteristic curve.

Figure 1 (A) A forest plot of independent risk variables with OR for all-cause mortality in patients with acute VTE. (B) The nomogram of the prediction model for mortality risk.

Abbreviations: PE, pulmonary embolism; PLR, platelet/lymphocyte ratio.

Figure 2 (A) The ROC curve of the prediction model in training set. (B) The ROC curve of the prediction model in validation set. (C) The calibration plot in training set. (D) The calibration plot in validation set.

Figure 3 Kaplan-meier analysis of survival probability based on the median value of the total point in the nomogram showed a significant difference between the ≥200 and <200 groups (Log rank p<0.001) in training set (A) and validation set (B). The DCA showed a better net benefit of the prediction model for mortality risk within threshold probability ranged from 0% to 19% in training set (C), and 0% to 13% in validation set (D).