Validation of risk assessment models predicting venous thromboembolism in acutely ill medical inpatients: A cohort study
Validation of risk assessment models predicting venous thromboembolism in acutely ill medical inpatients: A cohort study
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DOI：
10.1111/jth.14796
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发表时间：
2020-06-01
影响因子：
10.4
通讯作者：
Roy, Pierre-Marie
中科院分区：
文献类型：
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作者：
Moumneh, Thomas;Riou, Jeremie;Roy, Pierre-Marie
背景由于医院获得性静脉血栓栓塞症(VTE)是内科住院患者可预防死亡的常见原因，识别需要血栓预防的高危患者至关重要。我们的目标是外部评估Caprini、Improve和Padua VTE风险评分，并将其作为独立预测指标与高龄患者进行比较。方法我们对前瞻性纳入Prevenu试验的患者进行了回顾性分析。年龄在40岁及以上，在内科病房住院至少2天的患者连续入选并随访3个月。危重病人没有被招募。入院后48小时内确诊为静脉血栓栓塞者，或接受全剂量抗凝治疗或接受手术的患者被排除在外。在3个月的随访中，所有疑似静脉血栓栓塞症和死亡病例都由一个独立委员会裁决。对三项评分进行回顾性评估。结果14910例患者中，14660例可评价，其中1.8%的患者在3个月内发生症状性VTE或原因不明的猝死。受试者工作特征曲线下面积(AUC)分别为0.60(95%可信区间0.57~0.63)、0.63(95%可信区间0.60~0.66)和0.64(95%可信区间0.61~0.67)。作为单一预测因子，这些评分均未显著优于高龄患者(AUC 0.61，95%CI 0.58~0.64)。结论在我们的研究中，Caprini、Improve和Padua VTE风险评分对有VTE风险的非危重内科住院患者的辨别能力较差，且不比仅基于患者年龄的风险评估更好。
Background Because hospital-acquired venous thromboembolism (VTE) represents a frequent cause of preventable deaths in medical inpatients, identifying at-risk patients requiring thromboprophylaxis is critical. We aimed to externally assess the Caprini, IMPROVE, and Padua VTE risk scores and to compare their performance to advanced age as a stand-alone predictor.Methods We performed a retrospective analysis of patients prospectively enrolled in the PREVENU trial. Patients aged 40 years and older, hospitalized for at least 2 days on a medical ward were consecutively enrolled and followed for 3 months. Critical ill patients were not recruited. Patients diagnosed with VTE within 48 hours from admission, or receiving full dose anticoagulant treatment or who underwent surgery were excluded. All suspected VTE and deaths occurring during the 3-month follow-up were adjudicated by an independent committee. The three scores were retrospectively assessed. Body mass index, needed for the Padua and Caprini scores, was missing in 44% of patients.Results Among 14 910 eligible patients, 14 660 were evaluable, of which 1.8% experienced symptomatic VTE or sudden unexplained death during the 3-month follow-up. The area under the receiver operating characteristic curves (AUC) were 0.60 (95% confidence interval [CI] 0.57-0.63), 0.63 (95% CI 0.60-0.66) and 0.64 (95% CI 0.61-0.67) for Caprini, IMPROVE, and Padua scores, respectively. None of these scores performed significantly better than advanced age as a single predictor (AUC 0.61, 95% CI 0.58-0.64).Conclusion In our study, Caprini, IMPROVE, and Padua VTE risk scores have poor discriminative ability to identify not critically ill medical inpatients at risk of VTE, and do not perform better than a risk evaluation based on patient's age alone.