长期血液透析患者出血预测风险算法的开发和验证:国际前性队列研究 (BLEED-HD)
Mohit Madken1, Ranjeeta Mallick2, Emily Rhodes3
1Department of Medicine, The Ottawa Hospital, ON, Canada.
Canadian journal of kidney health and disease
|June 28, 2023
概括
维持血液透析的患者面临高出血风险. 一个新的预测方程,BLEED-HD,比现有的工具更有效地识别这些高风险个体,有助于缓解策略.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 心血管医学 心血管医学
- 流行病学 流行病学
背景情况:
- 患有病的患者,特别是接受维持血液透析的患者,患出血事件的风险显著增加.
- 有效识别高风险个体对于实施有针对性的缓解策略和改善患者治疗结果至关重要.
研究的目的:
- 开发和验证一种名为BLEED-HD的新型预测方程,专门用于识别患有高出血风险的接受维护血液透析的患者.
主要方法:
- 一项国际前性队列研究 (透析结果和实践模式研究 (DOPPS) 阶段2-6,2002-2018) 用于开发,涉及超过53,000名患者.
- 来自加拿大安大略省的19,000多名患者的回顾性队列研究作为外部验证队列.
- 考克斯的比例危险模型被用于开发BLEED-HD方程,该方程包含六个关键变量.
主要成果:
- BLEED-HD方程包括年龄,性别,国家,先前的胃肠道出血,假心,以及使用维生素K对抗剂.
- 在发育队列中,观察到的3年出血概率在风险分位数中从2.2%到10.8%不等,具有中度的歧视 (c-统计=0.65) 和优秀的校准.
- 在开发和验证队列中,BLEED-HD与现有的出血风险评分 (HEMORRHAGE,HAS-BLED,ATRIA) 相比,显示出更好的区分和校准.
结论:
- BLEED-HD风险方程提供了一个简单且可能更适用的工具,用于预测在维护血液透析患者的高风险人群中出血风险.
- 这种经过验证的工具可以帮助临床医生更好地分层出血风险,并为血液透析患者量身定制预防干预措施.
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