Development and validation of a risk model for hospitalacquired venous thrombosis: the Medical Inpatients Thrombosis and Hemostasis study

被引：9

作者：

Zakai, Neil A. ^{[1
,2
,3
,21
]}

Wilkinson, Katherine ^{[2
]}

Sparks, Andrew D. ^{[4
]}

Packer, Ryan T. ^{[2
]}

Koh, Insu ^{[2
,5
]}

Roetker, Nicholas S. ^{[6
]}

Repp, Allen B. ^{[1
,3
]}

Thomas, Ryan ^{[1
,3
]}

Holmes, Chris E. ^{[1
,3
]}

Cushman, Mary ^{[1
,2
,3
]}

Plante, Timothy B. ^{[1
,3
]}

Al-Samkari, Hanny ^{[7
]}

Pishko, Allyson M. ^{[8
]}

Wood, William A. ^{[9
]}

Masias, Camila ^{[1
,10
]}

Gangaraju, Radhika ^{[1
,11
]}

Li, Ang ^{[1
,2
,12
]}

Garcia, David ^{[1
,3
,13
]}

Wiggins, Kerri L. ^{[1
,4
,14
]}

Schaefer, Jordan K. ^{[1
,5
,15
]}

Hooper, Craig ^{[16
]}

Smith, Nicholas L. ^{[17
,18
,19
]}

Mcclure, Leslie A. ^{[20
]}

机构：

[1] Univ Vermont, Dept Med, Larner Coll Med, Burlington, VT USA

[2] Univ Vermont, Dept Pathol & Lab Med, Larner Coll Med, Burlington, VT USA

[3] Univ Vermont, Dept Med, Med Ctr, Burlington, VT USA

[4] Univ Vermont, Larner Coll Med, Dept Med Biostat, Burlington, VT USA

[5] SyllogisTeks, Chesterfield, MO USA

[6] Hennepin Healthcare Res Inst, Chron Dis Res Grp, Minneapolis, MN USA

[7] Harvard Med Sch, Massachusetts Gen Hosp, Dept Med, Boston, MA USA

[8] Univ Penn, Perelman Sch Med, Dept Med, Philadelphia, PA USA

[9] Univ N Carolina, Sch Med, Dept Med, Chapel Hill, NC USA

[10] Baptist Hlth South Florida, Miami Canc Inst, Coral Gables, FL USA

[11] Univ Alabama Birmingham, Inst Canc Outcomes & Survivorship, Birmingham, AL USA

[12] Baylor Coll Med, Sect Hematol Oncol, Houston, TX USA

[13] Univ Washington, Div Hematol, Sch Med, Seattle, WA USA

[14] Univ Washington, Dept Med, Seattle, WA USA

[15] Univ Michigan, Dept Internal Med, Div Hematol Oncol, Ann Arbor, MI USA

[16] CDCP, Div Blood Disorders, Atlanta, GA USA

[17] Kaiser Permanente Washington, Hlth Res Inst, Seattle, WA USA

[18] Univ Washington, Dept Epidemiol, Seattle, WA USA

[19] Seattle Epidemiol Res & Informat Ctr, Dept Vet Affairs, Off Res & Dev, Seattle, WA USA

[20] Drexel Univ, Dornsife Sch Publ Hlth, Dept Epidemiol & Biostat, Philadelphia, PA USA

[21] Univ Vermont, Lab Clin Biochem Res, Larner Coll Med, Suite 206,360 South Pk Dr, Colchester, VT 05446 USA

来源：

JOURNAL OF THROMBOSIS AND HAEMOSTASIS | 2024年 / 22卷 / 02期

基金：

美国国家卫生研究院;

关键词：

hospitalization; inpatients; risk assessment; risk factors; venous thrombosis; DEEP-VEIN THROMBOSIS; THROMBOEMBOLISM PROPHYLAXIS; HOSPITALIZED-PATIENTS; BLEEDING RISK; EXTERNAL VALIDATION; AMERICAN-COLLEGE; PREVENTION; VTE; IDENTIFICATION; GUIDELINES;

D O I：

10.1016/j.jtha.2023.10.015

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Regulatory organizations recommend assessing hospital -acquired (HA) venous thromboembolism (VTE) risk for medical inpatients. Objectives: To develop and validate a risk assessment model (RAM) for HA-VTE in medical inpatients using objective and assessable risk factors knowable at admission. Methods: The development cohort included people admitted to medical services at the University of Vermont Medical Center (Burlington, Vermont) between 2010 and 2019, and the validation cohorts included people admitted to Hennepin County Medical Center (Minneapolis, Minnesota), University of Michigan Medical Center (Ann Arbor, Michigan), and Harris Health Systems (Houston, Texas). Individuals with VTE at admission, aged <18 years, and admitted for <1 midnight were excluded. We used a Bayesian penalized regression technique to select candidate HA-VTE risk factors for final inclusion in the RAM. Results: The development cohort included 60 633 admissions and 227 HA-VTE, and the validation cohorts included 111 269 admissions and 651 HA-VTE. Seven HA-VTE risk factors with t statistics >= 1.5 were included in the RAM: history of VTE, low hemoglobin level, elevated creatinine level, active cancer, hyponatremia, increased red cell distribution width, and malnutrition. The areas under the receiver operating characteristic curve and calibration slope were 0.72 and 1.10, respectively. The areas under the receiver operating characteristic curve and calibration slope were 0.70 and 0.93 at Hennepin County Medical Center, 0.70 and 0.87 at the University of Michigan Medical Center, and 0.71 and 1.00 at Harris Health Systems, respectively. The RAM performed well stratified by age, sex, and race. Conclusion: We developed and validated a RAM for HA-VTE in medical inpatients. By quantifying risk, clinicians can determine the potential benefits of measures to reduce HA-VTE.

引用

页码：503 / 515

页数：13

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