静脉血栓栓塞在医疗住院患者中的风险评估模型
Emmanuel Häfliger1, Basil Kopp1, Pauline Darbellay Farhoumand2
1Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
JAMA network open
|May 10, 2024
概括
静脉血栓栓塞 (VTE) 的风险评估模型 (RAMs) 在医疗住院患者中显示了低于最佳的准确性. 需要新的策略,以便在住院患者中更好地预测和预防VTE.
科学领域:
- 内部医学 内部医学
- 心脏病学 心脏病学
- 血液学 血液学 血液学
背景情况:
- 血栓预防对于有风险发生静脉血栓塞栓症 (VTE) 的医疗住院患者至关重要.
- 有验证的风险评估模型 (RAM) 存在,用于分层VTE风险,但直接比较研究有限.
研究的目的:
- 为了前性验证VTE风险评估的简化日内瓦得分.
- 为了比较简化日内瓦得分对其他验证的RAM在医疗住院患者的预后性能.
主要方法:
- 一项前性队列研究包括1352名没有治疗性抗凝药的医疗住院患者.
- 四个RAMs (简化的日内瓦,原来的日内瓦,帕多瓦,IMPROVE) 用来分层VTE风险.
- 90天内出现症状的VTE是主要的结局指标.
主要成果:
- 2.1%的患者在90天内经历了VTE.
- 所有RAM都表现出低于最佳的区分性能,ROC曲线下的面积在53.8%至58.1%之间.
- 在调整后,在RAM中,在高风险和低风险组之间没有发现VTE风险的显著差异.
结论:
- 简化日内瓦评分和其他当前的RAM对于预测医院内获得的VTE在医疗住院患者中具有可疑的临床有用性.
- 现有的RAM表现出低于最佳的准确性和预后性能.
- 发展更准确的VTE预测策略至关重要.
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