Internal Medicine, Cleveland Clinic, Cleveland, OH, USA.
Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
Thromb Res. 2017 Oct;158:38-43. doi: 10.1016/j.thromres.2017.08.005. Epub 2017 Aug 12.
Bleeding and thrombosis are both major complications of hospitalization in cancer patients. Concern regarding bleeding risk may reduce compliance with thromboprophylaxis. We assessed incidence of major and clinically relevant non-major bleeding (MCRNMB) and identified risk factors associated with in-hospital bleeding risk in hospitalized cancer patients.
We conducted a retrospective cohort study of consecutive adults admitted to general oncology floor at Cleveland Clinic from 11/2012-12/2014 (n=3525). Patients were excluded for bleeding on admission (n=108), age<18 (n=1), non-malignant disease (n=2) and incomplete data (n=56). Data collected included demographics, body mass index (BMI), cancer type, length of stay (LOS), use of anticoagulants and baseline laboratory values (+48h). Univariate risk factors were identified with logistic regression analysis. Multivariable risk factors were identified with stepwise logistic regression and confirmed with bootstrap analysis.
The study population comprised 3358 patients of whom 69 (2.1%) developed MCRNMB. Median age was 62 (range, 19-98) years and 56% male. Median length of stay was 5 (range, 0-152) days. The majority of bleeding events were either gastrointestinal (GI) (N=23, 33%) or retroperitoneal (N=10, 14%). In multivariable analysis, anemia as the reason for admission (7.78, 95% CI 4.0-15.1, P<0.001), GI cancer site (2.96, 95% CI 1.7-5.2 P<0.001), BMI≥40 (3.08, 95% CI 1.3-2.9, P=0.008) and thrombocytopenia (1.7, 95% CI 1.0-2.9, P=0.05) were predictive.
The incidence of MCRNMB in a population of hospitalized cancer patients was 2.1%. Risk factors at admission included type of cancer and morbid obesity. Improved prediction of bleeding risk can assist physicians in optimizing selection of thromboprophylaxis in this population that is also at increased risk of VTE.
出血和血栓形成都是癌症患者住院的主要并发症。对出血风险的担忧可能会降低对血栓预防的依从性。我们评估了住院癌症患者的主要和临床相关非主要出血（MCRNMB）的发生率，并确定了与住院内出血风险相关的危险因素。
我们对克利夫兰诊所普通肿瘤病房 2012 年 11 月至 2014 年 12 月期间连续收治的成年患者进行了回顾性队列研究（n=3525）。因入院时出血（n=108）、年龄<18 岁（n=1）、非恶性疾病（n=2）和数据不完整（n=56）而排除患者。收集的数据包括人口统计学、体重指数（BMI）、癌症类型、住院时间（LOS）、抗凝药物的使用情况和入院后 48 小时内的实验室值。采用逻辑回归分析确定单变量危险因素。采用逐步逻辑回归确定多变量危险因素，并采用 bootstrap 分析进行验证。
该研究人群包括 3358 例患者，其中 69 例（2.1%）发生了 MCRNMB。中位年龄为 62 岁（范围 19-98 岁），56%为男性。中位 LOS 为 5 天（范围 0-152 天）。大多数出血事件为胃肠道（GI）（n=23，33%）或腹膜后（n=10，14%）。多变量分析中，入院时贫血的原因（7.78，95%CI 4.0-15.1，P<0.001）、GI 癌症部位（2.96，95%CI 1.7-5.2，P<0.001）、BMI≥40（3.08，95%CI 1.3-2.9，P=0.008）和血小板减少症（1.7，95%CI 1.0-2.9，P=0.05）是预测因素。
在住院癌症患者人群中，MCRNMB 的发生率为 2.1%。入院时的危险因素包括癌症类型和病态肥胖。出血风险预测的改善可以帮助医生在选择血栓预防方面做出更优决策，因为该人群也有更高的静脉血栓栓塞风险。
