用全国EHR数据验证癌症相关血栓的风险评分
Ang Li1, Omid Jafari1, Barbara D Lam2
1Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas.
JAMA network open
|November 25, 2025
概括
电子健康记录癌症相关血栓症 (EHR-CAT) 评分准确预测癌症患者的静脉血栓栓塞 (VTE) 风险,优于Khorana评分. 这个经过验证的工具使用易于获得的EHR数据来改善临床采用.
科学领域:
- 在瘤学瘤学.
- 血液学 血液学 血液学
- 临床信息学 临床信息学
- 流行病学 流行病学
背景情况:
- 静脉血栓塞栓症 (VTE) 对癌症患者造成显著的死亡和发病风险.
- 当前的VTE风险预测模型往往缺乏广泛的验证,阻碍了临床应用.
- 一个有效的,可访问的风险评分对于瘤学中主动的VTE管理至关重要.
研究的目的:
- 为了验证电子健康记录与癌症相关的血栓形成症 (EHR-CAT) 评分与 Khorana 评分在一个大规模的当代癌症患者队列中.
- 在排除高出血风险患者之前和之后评估EHR-CAT评分的表现.
- 评估使用结构化EHR数据用于VTE风险分层的可行性.
主要方法:
- 使用了全国纵向电子健康记录 (EHR) 数据库 (2018-2023年).
- 包括接受全身治疗的新诊断的固体或血液恶性瘤患者.
- 经验证的ICD-10-CM算法定义了VTE,出血和恶性瘤;抗凝血剂试验排除标准确定了高出血风险.
主要成果:
- 这项研究包括732,594名患者;6个月VTE发病率为4.7%.
- EHR-CAT得分显示出良好的区分能力 (C-统计,0.70-0.71),表现优于Khorana得分 (C-统计,0.63).
- EHR-CAT对20%的患者进行了重新分类,提高了预测准确度,并显示了各个子组的一致校准.
结论:
- EHR-CAT风险评分是外部验证的,可用于估计癌症患者的静脉瘤风险.
- 该分数有效地利用易于获得的结构化EHR数据.
- 这有助于在常规临床实践中改善VTE风险分层和管理.
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