title: A venous thromboembolism risk assessment model for patients with Cushing's syndrome.
abstract: Cushing's syndrome (CS) is associated with an incidence of venous thromboembolism (VTE) about ten times higher than in the normal population. The aim of our study was to develop a model for identifying CS patients at higher risk of VTE. We considered clinical, hormonal, and coagulation data from 176 active CS patients and used a forward stepwise logistic multivariate regression analysis to select the major independent risk factors for thrombosis. The risk of VTE was calculated as a 'CS-VTE score' from the sum of points of present risk factors. VTE developed in 20 patients (4 pulmonary embolism). The group of CS patients with VTE were older (p < 0.001) and had more cardiovascular events (p < 0.05), infections and reduced mobility (both p < 0.001), higher midnight plasma cortisol levels (p < 0.05), and shorter APTT (p < 0.01) than those without. We identified six major independent risk factors for VTE: age ≥69 years and reduced mobility were given two points each, whereas acute severe infections, previous cardiovascular events, midnight plasma cortisol level >3.15 times the normality and shortened APTT were given one point each. A CS-VTE score <2 anticipated no risk of VTE; a CS-VTE score of two mild risk (10 %); a CS-VTE score of three moderate risk (46 %); a CS-VTE score ≥4 high risk (85 %). Considering a score ≥3 as predictive of VTE, 94 % of the patients were correctly classified. A simple score helps stratify the VTE risk in CS patients and identify those who could benefit from thromboprophylaxis.
authors.affiliation: Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Via Ospedale, 105 35128, Padua, Italy. marialuisazilio@gmail.com.
authors.forename: Marialuisa
authors.initials: M
authors.lastname: Zilio
authors.affiliation: Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Via Ospedale, 105 35128, Padua, Italy.
authors.forename: Linda
authors.initials: L
authors.lastname: Mazzai
authors.affiliation: Clinical Medicine II, Department of Cardiac, Thoracic and Vascular Sciences, University-Hospital of Padova, Padua, Italy.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Sartori
authors.affiliation: Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Via Ospedale, 105 35128, Padua, Italy.
authors.forename: Mattia
authors.initials: M
authors.lastname: Barbot
authors.affiliation: Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Via Ospedale, 105 35128, Padua, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Ceccato
authors.affiliation: Clinical Medicine II, Department of Cardiac, Thoracic and Vascular Sciences, University-Hospital of Padova, Padua, Italy.
authors.forename: Viviana
authors.initials: V
authors.lastname: Daidone
authors.affiliation: Clinical Medicine II, Department of Cardiac, Thoracic and Vascular Sciences, University-Hospital of Padova, Padua, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Casonato
authors.affiliation: Clinical Medicine II, Department of Cardiac, Thoracic and Vascular Sciences, University-Hospital of Padova, Padua, Italy.
authors.forename: Graziella
authors.initials: G
authors.lastname: Saggiorato
authors.affiliation: Clinical Medicine V, Department of Medicine DIMED, University-Hospital of Padova, Padua, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Noventa
authors.affiliation: Endocrinology Unit, Polytechnic University of Marche, Ancona, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Trementino
authors.affiliation: Clinical Medicine II, Department of Cardiac, Thoracic and Vascular Sciences, University-Hospital of Padova, Padua, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Prandoni
authors.affiliation: Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Via Ospedale, 105 35128, Padua, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Boscaro
authors.affiliation: Endocrinology Unit, Polytechnic University of Marche, Ancona, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Arnaldi
authors.affiliation: Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Via Ospedale, 105 35128, Padua, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Scaroni
mesh_terms: D000328:Adult; D000368:Aged; D003480:Cushing Syndrome / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000209:etiology*
keywords: Cushing’s syndrome; Model; Risk; Score; Venous thromboembolism