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Predicting the risk of venous thromboembolism in critically ill patients (PROVE-IT): a model development and
Sean Christian Schuett Rivrud1, Èmese Robin Hélène Heijkoop2, Lisa Hulshof3
1Department of Intensive Care, University Medical Center Groningen, Groningen, the Netherlands; Department of Hematology, University Medical Center Groningen, Groningen, the Netherlands.
Background:
Venous thromboembolism (VTE) is a serious complication of critical illness. The persistently high rates of VTE may be the result of thromboprophylaxis failure in critically ill patients at particularly high risk of VTE. A prognostic model may facilitate patient-specific interventions, ultimately lowering the incidence of VTE in critically ill patients.
Objectives:
We aimed to develop and externally validate a prognostic model for VTE in critically ill patients: Predicting the Risk of Venous Thromboembolism in Critically Ill Patients model.
Methods:
The outcome was in-hospital VTE after intensive care unit admission. Model development was performed using multiple logistic regression with 14 established prognostic factors for VTE in critically ill patients. External validation was conducted in an independent cohort. Model performance was evaluated in terms of discrimination (C-statistic), calibration (integrated calibration index [ICI], E50, E90, Emax), and clinical utility (decision curve analysis [DCA]).
Results:
The Predicting the Risk of Venous Thromboembolism in Critically Ill Patients (PROVE-IT) model was developed in 26 218 patients and externally validated in 1983 patients. Discrimination was acceptable with a C-statistic of 0.681 upon internal validation and 0.629 upon external validation. Calibration was excellent internally (ICI = 0.00231; E50 = 0.00184; E90 = 0.00313; Emax = 0.452) and good externally (ICI = 0.00664; E50 = 0.00447; E90 = 0.00131; Emax = 0.154). DCA suggested that the model may have clinical benefit over a range of risk thresholds (1.1%-4.7%), although not statistically significant.
Conclusion:
We developed and externally validated a prognostic model for in-hospital VTE in critically ill patients. Our model was well-calibrated upon external validation, although the discrimination was merely acceptable. Additionally, the model's clinical utility, assessed by DCA, is unclear, which precludes its recommendation for clinical implementation at this stage.
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