Multicentre validation of the Geneva Risk Score for hospitalised medical patients at risk of venous thromboembolism Explicit ASsessment of Thromboembolic Risk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE)
Multicentre validation of the Geneva Risk Score for hospitalised medical patients at risk of venous thromboembolism Explicit ASsessment of Thromboembolic Risk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE)
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DOI：
10.1160/th13-05-0427
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发表时间：
2014-03-01
影响因子：
6.7
通讯作者：
Bounameaux, Henri
中科院分区：
文献类型：
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作者：
Nendaz, Mathieu;Spirk, David;Bounameaux, Henri
有必要验证风险评估工具，为住院的医疗患者的静脉血栓栓塞症（VTE）的风险。我们研究了预先定义的日内瓦风险评分临界值与帕多瓦预测评分相比，是否能准确区分低危I型和高危I型患者，无论是否使用血栓预防。在一项多中心、前瞻性明确评估瑞士医疗患者血栓栓塞风险和预防措施（ESTIMATE）队列研究中，纳入了1，478例住院医疗患者，其中637例（43%）未接受血栓预防。主要终点是90天时的症状性VIE或VIE相关死亡。该研究在ClinicalTrials.gov上注册，编号为NCT 01277536。根据日内瓦风险评分，主要终点的累积发生率为3.2%（95%置信区间[Cl] 2.2-4.6%），962例高风险vs 0.6%（95% CI 0.2-1.9%）;在未接受预防性治疗的患者中，该比率分别为3.5%和0.8%（p=0.029）。相比之下，Padua预测评分在714例高风险患者中产生的主要终点累积发生率为3.5%（95% CI 2.3-5.3%），在764例低风险患者中为1.1%（95% CI 0.6-2.3%）（p=0.002）;在未接受预防治疗的患者中，该发生率分别为3.2%和1.5%（p=0.130）。日内瓦风险评分的阴性似然比为0.28（95% CI 0.10-0.83），帕多瓦预测评分的阴性似然比为0.51（95% CI 0.28-0.93）。总之，在住院的内科患者中，日内瓦风险评分预测了VTE和VIE相关死亡率，并与帕多瓦预测评分相比具有优势，特别是其识别不需要血栓预防的低风险患者的准确性。
There is a need to validate risk assessment tools for hospitalised medical patients at risk of venous thromboembolism (VTE). We investigated whether a predefined cut-off of the Geneva Risk Score, as compared to the Padua Prediction Score, accurately distinguishes low-risk I from high-risk patients regardless of the use of thromboprophylaxis. In the multicentre, prospective Explicit ASsessment of Thromboembolic Risk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE) cohort study, 1,478 hospitalised medical patients were enrolled of whom 637 (43%) did not receive thromboprophylaxis. The primary endpoint was symptomatic VIE or VIE-related death at 90 days. The study is registered at ClinicalTrials.gov, number NCT01277536. According to the Geneva Risk Score, the cumulative rate of the primary endpoint was 3.2% (95% confidence interval [Cl] 2.2-4.6%) in 962 high-risk vs 0.6% (95% Cl 0.2-1.9%) in 516 low-risk patients (p=0.002); among patients without prophylaxis, this rate was 3.5% vs 0.8% (p=0.029), respectively. In comparison, the Padua Prediction Score yielded a cumulative rate of the primary endpoint of 3.5% (95% Cl 2.3-5.3%) in 714 high-risk vs 1.1% (95% Cl 0.6-2.3%) in 764 low-risk patients (p=0.002); among patients without prophylaxis, this rate was 3.2% vs 1.5% (p=0.130), respectively. Negative likelihood ratio was 0.28 (95% CI 0.10-0.83) for the Geneva Risk Score and 0.51 (95% Cl 0.28-0.93) for the Padua Prediction Score. In conclusion, among hospitalised medical patients, the Geneva Risk Score predicted VTE and VIE-related mortality and compared favourably with the Padua Prediction Score, particularly for its accuracy to identify low-risk patients who do not require thromboprophylaxis.