EVALUATION OF THE EFFICACY OF THE WELLS SCORING SYSTEM IN THE CLINICAL DIAGNOSIS OF DEEP VENOUS THROMBOSIS IN CHRONIC KIDNEY DISEASE PATIENTS

Abstract

Background:

Patients with chronic kidney disease (CKD) are prone to coagulation and vascular dysfunction and have a high morbidity and mortality risk of deep venous thrombosis (DVT). Although the Wells Scoring System is the most used algorithm to predict DVT risk, its accuracy in CKD populations remains unknown. 

Objective:

To study the performance of the Wells Scoring System in CKD patients 

Methods:

An descriptive cross-sectional study was undertaken in the period of six months in the nephrology department of Lady Reading Hospital Peshawar. Total 85 CKD patients (age ≥18 years) enrolled during consecutive sampling by presenting clinical signs of DVT. In all patients, clinical evaluation was performed using the Wells criteria before the compression duplex ultrasonography was performed as  the reference standard. SPSS version 25.0 was used for the analysis of the data. Mean ± standard deviation and percentages were used to express quantitative variables and categorical variables. The diagnostic performance of the Wells score was computed with a threshold of ≥2 points.

Results:

DVT was confirmed in 32 patients (37.6%). Sensitivity, specificity, PPV, and NPV for a Wells score ≥2 were 90.6%, 60.4, 58.0, 91.4, respectively. Tables, figures, illustrate fact data, including a pie chart showing patient distribution in the Wells risk categories and a scatter plot of Wells score vs. ultrasound findings.

Conclusion:

The sensitivity and NPV of the Wells scoring system in CKD patients are high enough to perform for ruling out DVT. Nevertheless, since specificity is moderate, confirmatory imaging is still required. These findings further propose the integration of the Wells score into an algorithm for the diagnosis of DVT in CKD patients, with its limitations.