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Validation of a Prognostic Score to Identify Hospitalized Patients with COVID-19 at Increased Risk for Bleeding

Introduction: Hospitalized patients with COVID-19 are at increased risk for venous thromboembolism (VTE), but also for bleeding. We previously derived a prognostic score including four variables (elevated D-dimer, elevated ferritin, critical illness, and therapeutic-dose anticoagulation) that identi...

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Autores principales: Demelo-Rodriguez, Pablo, Galeano-Valle, Francisco, Ordieres-Ortega, Lucía, Siniscalchi, Carmine, Martín Del Pozo, Mar, Fidalgo, Ángeles, Gil-Díaz, Aída, Lobo, José Luis, De Ancos, Cristina, Monreal, Manuel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8621368/
https://www.ncbi.nlm.nih.gov/pubmed/34835085
http://dx.doi.org/10.3390/v13112278
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author Demelo-Rodriguez, Pablo
Galeano-Valle, Francisco
Ordieres-Ortega, Lucía
Siniscalchi, Carmine
Martín Del Pozo, Mar
Fidalgo, Ángeles
Gil-Díaz, Aída
Lobo, José Luis
De Ancos, Cristina
Monreal, Manuel
author_facet Demelo-Rodriguez, Pablo
Galeano-Valle, Francisco
Ordieres-Ortega, Lucía
Siniscalchi, Carmine
Martín Del Pozo, Mar
Fidalgo, Ángeles
Gil-Díaz, Aída
Lobo, José Luis
De Ancos, Cristina
Monreal, Manuel
author_sort Demelo-Rodriguez, Pablo
collection PubMed
description Introduction: Hospitalized patients with COVID-19 are at increased risk for venous thromboembolism (VTE), but also for bleeding. We previously derived a prognostic score including four variables (elevated D-dimer, elevated ferritin, critical illness, and therapeutic-dose anticoagulation) that identified those at increased risk for major bleeding. Methods: We aimed to validate the score in a subsequent cohort of hospitalized patients with COVID-19 receiving standard-, intermediate- or therapeutic doses of VTE prophylaxis. We evaluated its capacity to predict major bleeding, non-major bleeding, and bleeding-related death. Results: The cohort included 972 patients from 29 hospitals, of whom 280 (29%) received standard-; 412 (42%) intermediate-, 157 (16%) therapeutic doses of VTE prophylaxis and 123 (13%) other drugs. Median duration of prophylaxis was 14.7 ± 10.3 days. Major bleeding occurred in 65 patients (6.7%) and non-major bleeding in 67 (6.9%). Thirty patients with major bleeding (46%) died within the first 30 days after bleeding. The prognostic score identified 203 patients (21%) at very low risk, 285 (29%) at low risk, 263 (27%) intermediate-risk and 221 (23%) at high risk for bleeding. Major bleeding occurred in 1.0%, 2.1%, 8.7% and 15.4% of the patients, respectively. Non-major bleeding occurred in 0.5%, 3.5%, 9.5% and 14.2%, respectively. The c-statistics was: 0.74 (95% confidence intervals [CI]: 0.68–0.79) for major bleeding, 0.73 (95% CI: 0.67–0.78) for non-major bleeding and 0.82 (95% CI: 0.76–0.87) for bleeding-related death. Conclusions: In hospitalized patients with COVID-19, we validated that a prognostic score including 4 easily available items may identify those at increased risk for bleeding.
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spelling pubmed-86213682021-11-27 Validation of a Prognostic Score to Identify Hospitalized Patients with COVID-19 at Increased Risk for Bleeding Demelo-Rodriguez, Pablo Galeano-Valle, Francisco Ordieres-Ortega, Lucía Siniscalchi, Carmine Martín Del Pozo, Mar Fidalgo, Ángeles Gil-Díaz, Aída Lobo, José Luis De Ancos, Cristina Monreal, Manuel Viruses Article Introduction: Hospitalized patients with COVID-19 are at increased risk for venous thromboembolism (VTE), but also for bleeding. We previously derived a prognostic score including four variables (elevated D-dimer, elevated ferritin, critical illness, and therapeutic-dose anticoagulation) that identified those at increased risk for major bleeding. Methods: We aimed to validate the score in a subsequent cohort of hospitalized patients with COVID-19 receiving standard-, intermediate- or therapeutic doses of VTE prophylaxis. We evaluated its capacity to predict major bleeding, non-major bleeding, and bleeding-related death. Results: The cohort included 972 patients from 29 hospitals, of whom 280 (29%) received standard-; 412 (42%) intermediate-, 157 (16%) therapeutic doses of VTE prophylaxis and 123 (13%) other drugs. Median duration of prophylaxis was 14.7 ± 10.3 days. Major bleeding occurred in 65 patients (6.7%) and non-major bleeding in 67 (6.9%). Thirty patients with major bleeding (46%) died within the first 30 days after bleeding. The prognostic score identified 203 patients (21%) at very low risk, 285 (29%) at low risk, 263 (27%) intermediate-risk and 221 (23%) at high risk for bleeding. Major bleeding occurred in 1.0%, 2.1%, 8.7% and 15.4% of the patients, respectively. Non-major bleeding occurred in 0.5%, 3.5%, 9.5% and 14.2%, respectively. The c-statistics was: 0.74 (95% confidence intervals [CI]: 0.68–0.79) for major bleeding, 0.73 (95% CI: 0.67–0.78) for non-major bleeding and 0.82 (95% CI: 0.76–0.87) for bleeding-related death. Conclusions: In hospitalized patients with COVID-19, we validated that a prognostic score including 4 easily available items may identify those at increased risk for bleeding. MDPI 2021-11-15 /pmc/articles/PMC8621368/ /pubmed/34835085 http://dx.doi.org/10.3390/v13112278 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Demelo-Rodriguez, Pablo
Galeano-Valle, Francisco
Ordieres-Ortega, Lucía
Siniscalchi, Carmine
Martín Del Pozo, Mar
Fidalgo, Ángeles
Gil-Díaz, Aída
Lobo, José Luis
De Ancos, Cristina
Monreal, Manuel
Validation of a Prognostic Score to Identify Hospitalized Patients with COVID-19 at Increased Risk for Bleeding
title Validation of a Prognostic Score to Identify Hospitalized Patients with COVID-19 at Increased Risk for Bleeding
title_full Validation of a Prognostic Score to Identify Hospitalized Patients with COVID-19 at Increased Risk for Bleeding
title_fullStr Validation of a Prognostic Score to Identify Hospitalized Patients with COVID-19 at Increased Risk for Bleeding
title_full_unstemmed Validation of a Prognostic Score to Identify Hospitalized Patients with COVID-19 at Increased Risk for Bleeding
title_short Validation of a Prognostic Score to Identify Hospitalized Patients with COVID-19 at Increased Risk for Bleeding
title_sort validation of a prognostic score to identify hospitalized patients with covid-19 at increased risk for bleeding
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8621368/
https://www.ncbi.nlm.nih.gov/pubmed/34835085
http://dx.doi.org/10.3390/v13112278
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