Validation of the IMPROVE-DD risk assessment model for venous thromboembolism among hospitalized patients with COVID-19.
Validation of the IMPROVE-DD risk assessment model for venous thromboembolism among hospitalized patients with COVID-19.
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在COVID-19住院患者中验证静脉血栓栓塞的IMPROVE-DD风险评估模型。
DOI：
10.1002/rth2.12486
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发表时间：
2021-03
影响因子：
4.6
通讯作者：
COVID‐19 Consortium Group
中科院分区：
文献类型：
--
作者：
Spyropoulos AC;Cohen SL;Gianos E;Kohn N;Giannis D;Chatterjee S;Goldin M;Lesser M;Coppa K;Hirsch JS;McGinn T;Barish MA;COVID‐19 Consortium Group
针对2019冠状病毒病（COVID-19）住院患者的抗血栓指南声明建议了一种通用的血栓预防策略，有可能在高风险患者中增加剂量。到目前为止，还没有明确的方法来区分静脉血栓栓塞（VTE）的高风险患者。本研究的目的是在多医院卫生系统内的大型COVID-19住院患者队列中对VTE的IMPROVE-DD风险评估模型（RAM）进行外部验证。这项回顾性队列研究评估了2020年3月1日至2020年4月27日期间住院的COVID-19成人住院患者的IMPROVE-DD RAM。通过放射科成像或床旁超声诊断新发急性深静脉血栓形成或肺栓塞定义VTE。绘制受试者工作特征（ROC）曲线，计算曲线下面积（AUC），计算敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。共纳入9407例患者，VTE患病率为2.9%。IMPROVE-DD评分为0 - 1（低风险）的VTE发生率为0.4%，评分为2 - 3（中度风险）的VTE发生率为1.3%，评分≥ 4（高风险）的VTE发生率为5.3%。大约45%的总人口得分高VTE风险，而21%的得分低VTE风险。IMPROVE-DD区分低风险与中/高风险的灵敏度为0.971，特异性为0.218，PPV为0.036，NPV为0.996。ROC AUC为0.702。在这项大型外部验证研究中，IMPROVE-DD VTE RAM显示出非常好的区分力，可将COVID-19住院患者识别为低、中和高VTE风险，并有可能个性化血栓预防策略。
Antithrombotic guidance statements for hospitalized patients with coronavirus disease 2019 (COVID‐19) suggest a universal thromboprophylactic strategy with potential to escalate doses in high‐risk patients. To date, no clear approach exists to discriminate patients at high risk for venous thromboembolism (VTE). The objective of this study is to externally validate the IMPROVE‐DD risk assessment model (RAM) for VTE in a large cohort of hospitalized patients with COVID‐19 within a multihospital health system. This retrospective cohort study evaluated the IMPROVE‐DD RAM on adult inpatients with COVID‐19 hospitalized between March 1, 2020, and April 27, 2020. Diagnosis of VTE was defined by new acute deep venous thrombosis or pulmonary embolism by Radiology Department imaging or point‐of‐care ultrasound. The receiver operating characteristic (ROC) curve was plotted and area under the curve (AUC) calculated. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using standard methods. A total of 9407 patients were included, with a VTE prevalence of 2.9%. The VTE rate was 0.4% for IMPROVE‐DD score 0‐1 (low risk), 1.3% for score 2‐3 (moderate risk), and 5.3% for score ≥ 4 (high risk). Approximately 45% of the total population scored high VTE risk, while 21% scored low VTE risk. IMPROVE‐DD discrimination of low versus medium/high risk showed sensitivity of 0.971, specificity of 0.218, PPV of 0.036, and NPV of 0.996. ROC AUC was 0.702. The IMPROVE‐DD VTE RAM demonstrated very good discrimination to identify hospitalized patients with COVID‐19 as low, moderate, and high VTE risk in this large external validation study with potential to individualize thromboprophylactic strategies.
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影响因子：
9.6
作者：
Spyropoulos, Alex C.;Anderson, Frederick A., Jr.;Spencer, Frederick A.
通讯作者：
Spencer, Frederick A.
影响因子：
6.7
作者：
Mahan, Charles E.;Liu, Yang;Spyropoulos, Alex C.
通讯作者：
Spyropoulos, Alex C.
影响因子：
13.3
作者：
Zeng, D. X.;Xu, J. L.;Xu, L.
通讯作者：
Xu, L.
DOI：
10.1111/jth.14817
发表时间：
2020-05
期刊：
Journal of thrombosis and haemostasis : JTH
影响因子：
--
作者：
通讯作者：
--
影响因子：
4.6
作者：
Spyropoulos AC;Cohen SL;Gianos E;Kohn N;Giannis D;Chatterjee S;Goldin M;Lesser M;Coppa K;Hirsch JS;McGinn T;Barish MA;COVID‐19 Consortium Group
通讯作者：
COVID‐19 Consortium Group