[Thromboelastography Combined with Blood D-Dimer in the Prediction of Lower Extremity Venous Thrombosis in Patients with Diffuse Large B-Cell Lymphoma].

OBJECTIVE

To investigate the predictive value of thromboelastogram(TEG) combined with blood D-dimer in patients with diffuse large B-cell lymphoma(DLBCL) complicated with venous thromboembolism(VTE) of lower extremities.

METHODS

A total of 155 patients diagnosed with DLBCL in our hospital from August 2022 to August 2024 were collected as the research objects. Among them, 73 patients received lower extremity arteriovenous color Doppler ultrasound, and 14 patients with lower extremity venous thrombosis were detected, 59 cases were not detected, which were included in the VTE group and non-VTE group, respectively. The TEG parameters including coagulation angle(Angle), comprehensive coagulation index(CI), clotting time(K), maximum amplitude(MA), coagulation reaction time(R), together with blood D-dimer level, international prognostic index and whether it was relapsed or refractory were compared between the two groups. Multivariate Logistic regression analysis was used to explore the independent influencing factors of VTE formation in all patients. The area under the curve(AUC) of the receiver operating characteristic (ROC) curve was used to evaluate the predictive value of each parameter for VTE.

RESULTS

There was no significant difference in gender and age between the VTE group and the non-VET group (all P >0.05). The number of high-risk and relapse/refractory patients in the VTE group was significantly higher than that in the non-VTE group(all P < 0.05). Angle and CI in VTE group were significantly higher than those in non-VTE group(all P < 0.05), K value and R value were significantly lower than those in non-VTE group(all P < 0.05), and blood D-dimer level was significantly higher than that in non-VTE group (all P < 0.05). Multivariate logistic regression analysis showed that R value was an independent protective factor for VTE in patients with DLBCL (OR =0.256, P < 0.05 ), however, Ann Arbor stage (OR =3.885, P < 0.05 ) was independent risk factors for VTE in patients with DLBCL. The results of ROC curve analysis showed that there was no significant difference in the sensitivity of TEG (TEG group) prediction and TEG combined with blood D-dimer level (combined group) in predicting VTE in patients with DLBCL (92.86%,85.71%) and the sensitivity of blood D-dimer level (D-dimer group) prediction (71.43%) (P >0.05). There was no significant difference in the specificity between TEG group prediction (74.58%) and combined group prediction (81.36%), TEG group prediction and D-dimer group prediction ( 64.41 % ) (P >0.05). However, the specificity of the combined group was higher than that of the D-dimer group (χ2=4.288, P < 0.05). The AUC of the TEG group (0.901) and the combined group (0.915) was higher than that of the D-dimer group (0.692) ( Z=2.647, P < 0.05; Z=3.106, P < 0.05), but there was no significant difference in AUC between TEG group prediction and combined group prediction (P >0.05).

CONCLUSION

TEG and blood D-dimer levels have certain predictive efficacy for VTE in DLBCL patients, but TEG combined with blood D-dimer level has higher clinical value for VTE in DLBCL patients, which is worthy of clinical promotion.