Prediction value of Wells score combined with serum fibrinogen and D-dimer in deep venous thrombosis after hip arthroplasty under general anesthesia

Di Yujie; He Jia; Liu Xia; Wang Lishan; An Cuiyu; Li Xiaojing; Yang Liwei

doi:10.11986/j.issn.1673-873X.2025.10.14

Abstract：Objective To explore the predictive value of Wells score combined with serum fibrinogen(FIB)and D-dimer(D-D)for deep vein thrombosis(DVT)after hip arthroplasty(HA)under general anesthesia,in order to provide a reference for clini-cal decision-making.Methods A total of 126 patients who underwent hip arthroplasty under general anesthesia at Xingtai Gen-eral Hospital,North China Medical Health Group,from January 2023 to December 2024 were included in the study.According to the ultrasound diagnosis results 14 days post-surgery,the patients were assigned to the DVT group(n=28)and the non-DVT group(n=98).Clinical data were collected,Wells score was calculated,and serum FIB and D-D levels were measured within 24 hours after admission.Spearman correlation analysis was used to assess the correlation between Wells score and ser-um FIB and D-D levels with DVT formation after HA surgery.Logistic regression analysis was performed to identify the risk factors for DVT formation after HA surgery.Receiver operating characteristic(ROC)curves were used to analyze the predic-tive value of Wells score and serum FIB and D-D levels for DVT formation after HA,and the area under the curve(AUC)was compared using the Delong test.Results There were no significant differences between the DVT group and the non-DVT group in average age,gender distribution,and surgical duration(P>0.05).The proportion of patients with a Wells score≥3 and the levels of serum FIB and D-D were significantly higher in the DVT group than in the non-DVT group(P<0.05).Spearman correlation analysis showed that both Wells score and serum D-D level were significantly positively correlated with DVT formation after HA(P<0.05).Logistic regression analysis revealed that a Wells score≥3(OR=32.267,95%CI:10.583-98.374),high serum FIB(OR=1.859,95%CI:1.176-2.939),and high D-D(OR=25.981,95%CI:1.553-434.640)levels were independent risk factors for DVT formation after HA surgery(P<0.05).Wells score and serum FIB and D-D levels showed predictive value for DVT formation after HA surgery,with AUCs of 0.842(95%CI:0.766-0.901),0.604(95%CI:0.513-0.690),and 0.626(95%CI:0.535-0.710),respectively.The AUC of the combined prediction model was 0.910(95%CI:0.846-0.954),which was significantly higher than the AUC of the single indicator prediction model(P<0.05).Conclusion The Wells score helps to screen high-risk populations,FIB reflects the degree of coagulation activation,and D-D indicates the dynamic changes of the fibrinolytic system.The combination of these three factors offers a more comprehensive assessment of DVT risk.