[Value of Wells score combined with D-dimer detection in predicting the risk of deep vein thrombosis before ankle fracture surgery].

OBJECTIVE: To explore t predictive value of Wells score combined with D-dimer (D-D) test for the risk of deep venous thrombosis(DVT) before ankle fracture surgery.

METHODS: From May 2023 to May 2024, clinical data of 80 patients with ankle fractures were retrospective analyzed, included 50 males and 30 females;age from 35 to 69 years old with an average of (52.61±8.91) years old;body mass index (BMI) ranged from 20.5 to 24.9 kg·m-2 with an average of (23.41±2.09) kg·m-2;43 patients caused by high-energy injuries and 37 patients by low-energy injuries;30 patients with single ankle fractures and 50 patients with multiple ankle fractures;21 patients had combined vascular and nerve injuries;13 patients had a history of diabetes;the time from injury to medical consultation ranged from 40 to 103 min (69.77±5.53) min;preoperative waiting time ranged from 19 to 38 min with an average of (25.98±10.24) min;preoperative risk assessment and prediction (RAPT) score ranged from 6 to 11points with an average of (8.02±1.87) points. The patients were divided into DVT group (21 patients) and non-DVT group (59 patients) based on whether DVT occurred. Wells scores, D-D levels, thrombin-antithrombin complex (TAT), plasmin-α2-plasmin inhibitor complex (PIC), thrombomodulin (TM), and tissue plasminogen activator-inhibitor complex (t-PAIC) between two groups were conducted by Pearson correlation analysis. Logistic regression was used to analyze risk factors for DVTin ankle fractures, receiver operating characteristic curve (ROC) was employed to evaluate diagnostic value of Wells score and D-D levels for DVT of ankle joint.

RESULTS: There were statistically significant differences in proportion of high-energy injuries, the proportion of combined nerve and vascular injuries, the time from injury to medical consultation, Wells score, D-D, TAT, PIC, TM, and t-PAIC between non-DVT group and DVT group (P<0.05). Pearson correlation analysis results showed TAT (r=0.291, P=0.009), PIC (r=0.254, P=0.023), TM (r=0.469, P<0.001), and t-PAIC (r=0.598, P<0.001) were positively correlated with Wells score;TAT (r=0.308, P=0.005), PIC (r=0.340, P=0.002), TM (r=0.501, P<0.001), and t-PAIC (r=0.650, P<0.001) were positively correlated with D-D level. Logistic regression analysis showed high-energy injury [OR=3.390, 95%CI(1.950, 4.713), P=0.004], combined with vascular and nerve injury[OR=2.169, 95%CI(1.494, 3.610), P<0.001], elevated TAT level[OR=3.965, 95%CI(2.569, 5.474), P<0.001], increased Wells score[OR=1.233, 95%CI(0.905, 1.761), P=0.032], and elevated D-D level[OR=2.087, 95%CI(0.356, 3.881), P<0.001] were all risk factors for the occurrence of DVT after ankle fracture surgery;ROC curve analysis showed area under the curve (AUC) for combined diagnosis of Wells score, D-D level, and their combination were 0.674[95%CI(0.549, 0.799), P=0.018], 0.656[95%CI(0.510, 0.801), P=0.035], and 0.837[95% CI(0.727, 0.947), P<0.001], respectively. The combined diagnosis was > Wells score >D-D level (P<0.05).

CONCLUSION: Wells score and D-D level of patients with ankle joint fracture and DVT showed a significant increase. The combined detection of these two indicators has a better diagnostic value for ankle joint fracture DVT than the detection of a single indicator, and it has good clinical value.