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External Validation of the IMPROVE Risk Score for Predicting Bleeding in Hospitalized COVID-19 Patients
Yuzhi Tao1,2, Feiya Xu3, Jing Han4
1The First Bethune Hospital of Jilin University, Jilin University, Changchun, China.
Insights
The IMPROVE Bleeding Risk Score effectively predicts major bleeding in hospitalized COVID-19 patients. This tool aids in guiding low molecular weight heparin thromboprophylaxis decisions, especially for elderly individuals.
Area of Science:
- Internal Medicine
- Critical Care Medicine
- Cardiology
Background:
- COVID-19 patients face elevated risks of thrombosis and bleeding.
- A standardized tool for assessing bleeding risk in these patients is currently lacking.
Purpose of the Study:
- To evaluate the predictive capability of the IMPROVE Bleeding Risk Score (BRS) for major bleeding events in hospitalized COVID-19 patients.
- To assess the score's performance in guiding thromboprophylaxis strategies.
Main Methods:
- A prospective, multicenter cohort study included 3,886 hospitalized COVID-19 patients.
- The IMPROVE BRS was assessed for its predictive value of major bleeding (MB) and clinically relevant non-major bleeding (CRNMB) over 90 days.
- Statistical analyses included hazard ratios (HRs), predictive values, and area under the receiver operating characteristic curve (AUC).
Main Results:
- The IMPROVE BRS demonstrated strong predictive performance for MB events (AUC=0.84) and good calibration.
- High-risk patients exhibited significantly higher bleeding risks, even when adjusted for low molecular weight heparin (LMWH) thromboprophylaxis.
- LMWH thromboprophylaxis was associated with increased MB risk in elderly, high-risk patients.
Conclusions:
- The IMPROVE BRS is effective in predicting major bleeding risk among COVID-19 patients.
- The score offers valuable guidance for LMWH thromboprophylaxis, particularly in elderly COVID-19 patients.
- Further validation in diverse populations and refinement of threshold values are recommended.
Background:
COVID-19 patients are at increased risk of thrombosis and bleeding, but no standardized bleeding risk assessment tool has been recommended.
Objective:
This study evaluates the predictive value of the IMPROVE Bleeding Risk Score (BRS) in hospitalized COVID-19 patients.
Design:
A multicenter, prospective cohort of 3,886 hospitalized COVID-19 patients across six tertiary hospitals in China between December 1, 2022, and January 31, 2023.
Participants:
Patients were objectively diagnosed with COVID-19 by pathogen or antibody detection and followed for 90 days.
Main Measures:
The primary outcomes were major bleeding (MB) and clinically relevant non-major bleeding (CRNMB). We evaluated the IMPROVE BRS predictive performance using hazard ratios (HRs), positive and negative predictive values, the area under the receiver operating characteristic curve (AUC), and calibration.
Key Results:
Among 3,886 hospitalized COVID-19 patients (median age 74, IQR 62-84), 42 MB (1.1%) and 47 CRNMB (1.2%) events occurred within 90 days. The IMPROVE BRS performed well in predicting MB events, with an AUC of 0.84 (95% CI, 0.77-0.91) at 90 days. Calibration plots indicated good calibration. High-risk patients had a significantly higher bleeding risk than low-risk patients, even after adjusting for low molecular weight heparin (LMWH) thromboprophylaxis (MB: adjusted HR 6.63, 95% CI 3.62-12.15; CRNMB: adjusted HR 3.69, 95% CI 2.04-6.71). Subgroup analysis indicated that LMWH thromboprophylaxis significantly increased MB risk in elderly patients with high bleeding risk (14 days: adjusted HR 5.45, 95% CI 1.15-25.94; 30 days: adjusted HR 4.16, 95% CI 1.11-15.53).
Conclusions:
The IMPROVE BRS effectively predicted MB risk in COVID-19 patients and provided valuable guidance for LMWH thromboprophylaxis in elderly patients. Further research is needed to validate its applicability in different populations and refine threshold values for improved predictive accuracy.
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