Titre
Prediction of in-hospital bleeding in acutely ill medical patients: External validation of the IMPROVE bleeding risk score.
Type
article
Institution
UNIL/CHUV/Unisanté + institutions partenaires
Auteur(s)
Villiger, R.
Auteure/Auteur
Julliard, P.
Auteure/Auteur
Darbellay Farhoumand, P.
Auteure/Auteur
Choffat, D.
Auteure/Auteur
Tritschler, T.
Auteure/Auteur
Stalder, O.
Auteure/Auteur
Rossel, J.B.
Auteure/Auteur
Aujesky, D.
Auteure/Auteur
Méan, M.
Auteure/Auteur
Baumgartner, C.
Auteure/Auteur
Liens vers les personnes
Liens vers les unités
ISSN
1879-2472
Statut éditorial
Publié
Date de publication
2023-10
Volume
230
Première page
37
Dernière page/numéro d’article
44
Peer-reviewed
Oui
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: ppublish
Publication Status: ppublish
Résumé
Pharmacological thromboprophylaxis slightly increases bleeding risk. The only risk assessment model to predict bleeding in medical inpatients, the IMPROVE bleeding risk score, has never been validated using prospectively collected outcome data.
We validated the IMPROVE bleeding risk score in a prospective multicenter cohort of medical inpatients. Primary outcome was in-hospital clinically relevant bleeding (CRB) within 14 days of admission, a secondary outcome was major bleeding (MB). We classified patients according to the score in high or low bleeding risk. We assessed the score's predictive performance by calculating subhazard ratios (sHRs) adjusted for thromboprophylaxis use, positive and negative predictive values (PPV, NPV), and the area under the receiver operating characteristic curves (AUC).
Of 1155 patients, 8 % were classified as high bleeding risk. CRB and MB within 14 days occurred in 0.94 % and 0.47 % of low-risk and in 5.6 % and 3.4 % of high-risk patients, respectively. Adjusted for thromboprophylaxis, classification in the high-risk group was associated with an increased risk of 14-day CRB (sHR 4.7, 95 % confidence interval [CI] 1.5-14.5) and MB (sHR 4.9, 95%CI 1.0-23.4). PPV was 5.6 % and 3.4 %, while NPV was 99.1 % and 99.5 % for CRB and MB, respectively. The AUC was 0.68 (95%CI 0.66-0.71) for CRB and 0.73 (95%CI 0.71-0.76) for MB.
The IMPROVE bleeding risk score showed moderate to good discriminatory power to predict bleeding in medical inpatients. The score may help identify patients at high risk of in-hospital bleeding, in whom careful assessment of the risk-benefit ratio of pharmacological thromboprophylaxis is warranted.
We validated the IMPROVE bleeding risk score in a prospective multicenter cohort of medical inpatients. Primary outcome was in-hospital clinically relevant bleeding (CRB) within 14 days of admission, a secondary outcome was major bleeding (MB). We classified patients according to the score in high or low bleeding risk. We assessed the score's predictive performance by calculating subhazard ratios (sHRs) adjusted for thromboprophylaxis use, positive and negative predictive values (PPV, NPV), and the area under the receiver operating characteristic curves (AUC).
Of 1155 patients, 8 % were classified as high bleeding risk. CRB and MB within 14 days occurred in 0.94 % and 0.47 % of low-risk and in 5.6 % and 3.4 % of high-risk patients, respectively. Adjusted for thromboprophylaxis, classification in the high-risk group was associated with an increased risk of 14-day CRB (sHR 4.7, 95 % confidence interval [CI] 1.5-14.5) and MB (sHR 4.9, 95%CI 1.0-23.4). PPV was 5.6 % and 3.4 %, while NPV was 99.1 % and 99.5 % for CRB and MB, respectively. The AUC was 0.68 (95%CI 0.66-0.71) for CRB and 0.73 (95%CI 0.71-0.76) for MB.
The IMPROVE bleeding risk score showed moderate to good discriminatory power to predict bleeding in medical inpatients. The score may help identify patients at high risk of in-hospital bleeding, in whom careful assessment of the risk-benefit ratio of pharmacological thromboprophylaxis is warranted.
PID Serval
serval:BIB_4B58E914B673
PMID
Date de création
2023-09-20T09:55:52.274Z
Date de création dans IRIS
2025-05-20T13:37:27Z
Fichier(s)![Vignette d'image]()
En cours de chargement...
Nom
Prediction-of-in-hospital-bleeding-in-acutely-ill-.pdf
Version du manuscrit
published
Licence
https://creativecommons.org/licenses/by/4.0
Taille
959.88 KB
Format
Adobe PDF
PID Serval
serval:BIB_4B58E914B673.P001
Somme de contrôle
(MD5):c263afb12bb2e109f760822339b12feb