title: Testing Clinical Scores to Diagnose Incident Deep Vein Thrombosis in Patients Hospitalized in a Department of Medicine: Can Biomarkers Improve Accuracy?
abstract: Shifting the context from the emergency department to the department of medicine, we compared different scores to diagnose deep vein thrombosis (DVT) in patients with several comorbidities, hospitalized in a department of internal medicine. We prospectively recruited 178 consecutive hospitalized patients in whom clinical suspicion of DVT was assessed by Wells modified score for DVT, Hamilton, Kahn, and St Andrè Hospital scores. Deep vein thrombosis was confirmed in 85 (48%) patients by both echocolor Doppler and angiocomputed tomography scan. The use of risk scores based on symptoms and clinical signs was weakly useful (area under the curve [AUC]: 0.69, positive predictive value: 59%, and negative predictive value: 74%). Patients with DVT had significantly (P < .0001) lower serum albumin and protein S levels compared to those without DVT. Moreover, serum protein S (AUC: 0.82) and albumin in percentage (AUC: 0.80) showed a better accuracy than clinical scores (P < .001) in assessing the diagnosis of DVT. Therefore, serum albumin and protein S improved the accuracy of clinical scores for the diagnosis of incident DVT in patients hospitalized in a department of medicine.
authors.affiliation: Department of Clinical and Experimental Medicine, Unit of Internal Medicine, c/o Ospedale Cannizzaro, Catania, Italy malatino@unict.it.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Malatino
authors.affiliation: Department of Clinical and Experimental Medicine, Unit of Internal Medicine, c/o Ospedale Cannizzaro, Catania, Italy.
authors.forename: Antonella M
authors.initials: AM
authors.lastname: Cardella
authors.affiliation: Department of Clinical and Experimental Medicine, Unit of Internal Medicine, c/o Ospedale Cannizzaro, Catania, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Puccia
authors.affiliation: Department of Clinical and Experimental Medicine, Unit of Internal Medicine, c/o Ospedale Cannizzaro, Catania, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Cilia
authors.affiliation: Department of Clinical and Experimental Medicine, Unit of Internal Medicine, c/o Ospedale Cannizzaro, Catania, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Terranova
authors.affiliation: Department of Clinical and Experimental Medicine, Unit of Internal Medicine, c/o Ospedale Cannizzaro, Catania, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Cataudella
authors.affiliation: Department of Clinical and Experimental Medicine, Unit of Internal Medicine, c/o Ospedale Cannizzaro, Catania, Italy.
authors.forename: Agata
authors.initials: A
authors.lastname: Buonacera
authors.affiliation: CNR-IFC-IBIM, Ospedali Riuniti, Reggio Calabria, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Tripepi
authors.affiliation: Department of Clinical and Experimental Medicine, Unit of Internal Medicine, c/o Ospedale Cannizzaro, Catania, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Di Marca
authors.affiliation: Department of Clinical and Experimental Medicine, Unit of Internal Medicine, c/o Ospedale Cannizzaro, Catania, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Mastrosimone
authors.affiliation: Department of Clinical and Experimental Medicine, Unit of Internal Medicine, c/o Ospedale Cannizzaro, Catania, Italy.
authors.forename: Marcella
authors.initials: M
authors.lastname: Pisano
authors.affiliation: Department of Medical, Surgical, Neurologic, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Giordano
authors.affiliation: Department of Clinical and Experimental Medicine, Unit of Internal Medicine, c/o Ospedale Cannizzaro, Catania, Italy.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Stancanelli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D015897:Comorbidity; D003661:Decision Support Techniques; D005260:Female; D006748:Hospital Departments; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010690:Phlebography / Q000379:methods; D011237:Predictive Value of Tests; D011446:Prospective Studies; D017293:Protein S / Q000032:analysis; D012372:ROC Curve; D015203:Reproducibility of Results; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D000075462:Serum Albumin, Human; D014057:Tomography, X-Ray Computed; D018615:Ultrasonography, Doppler, Color; D020246:Venous Thrombosis / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology
chemical_list: C422455:ALB protein, human; D015415:Biomarkers; D017293:Protein S; D012709:Serum Albumin; D000075462:Serum Albumin, Human
keywords: deep vein thrombosis; hypoalbuminemia; protein S; risk score; venous thromboembolism