Liu Jia, Wang Guanyun, Qin Liu'an, Wu Yangxun, Zou Yuting, Wang Xuyun, Wang Ziqian, Wang Yuyan, Zhang Shizhao, Zhang Yuxiao, Yin Tong
Institute of Geriatrics, National Clinical Research Center for Geriatric Diseases, 2 Medical Center, Medical School of Chinese PLA and Chinese PLA General Hospital, Beijing 10053, China.
Department of Cardiology, 1 Medical Center, Medical School of Chinese PLA, Beijing 10053, China.
Cardiol Res Pract. 2021 Nov 23;2021:9030005. doi: 10.1155/2021/9030005. eCollection 2021.
This study aimed to analyse the role of the HAS-BLED score with the addition of genotype bins for bleeding risk prediction in warfarin-treated patients with atrial fibrillation (AF).
Consecutive patients with AF on initial warfarin treatment were recruited. For each patient, CYP2C9 3 and VKORC1-1639 A/G genotyping was performed to create 3 genotype functional bins. The predictive values of the HAS-BLED score with or without the addition of genotype bins were compared. According to the carrier status of the genotype bins, the numbers of normal, sensitive, and highly sensitive responders among 526 patients were 64 (12.17%), 422 (80.23%), and 40 (7.60%), respectively. A highly sensitive response was independently associated with clinically relevant bleeding (HR: 3.85, 95% CI: 1.88-7.91, =0.001) and major bleeding (HR:3.75, 95% CI: 1.17-11.97, =0.03). With the addition of genotype bins, the performance of the HAS-BLED score for bleeding risk prediction was significantly improved (c-statistic from 0.60 to 0.64 for clinically relevant bleeding and from 0.64 to 0.70 for major bleeding, < 0.01). Using the integrated discriminatory, net reclassification improvement, and decision curve analysis, the HAS-BLED score plus genotype bins could perform better in predicting any clinically relevant bleeding than the HAS-BLED score alone.
Genotypes have an incremental predictive value when combined with the HAS-BLED score for the prediction of clinically relevant bleeding in warfarin-treated patients with AF.
本研究旨在分析在华法林治疗的心房颤动（AF）患者中，增加基因型分组的HAS - BLED评分在出血风险预测中的作用。
招募首次接受华法林治疗的连续性AF患者。对每位患者进行CYP2C9 3和VKORC1 - 1639 A/G基因分型，以创建3个基因型功能分组。比较了添加或不添加基因型分组的HAS - BLED评分的预测价值。根据基因型分组的携带状态，526例患者中正常、敏感和高度敏感反应者的数量分别为64例（12.17%）、422例（80.23%）和40例（7.60%）。高度敏感反应与临床相关出血（HR：3.85，95%CI：1.88 - 7.91，P = 0.001）和大出血（HR：3.75，95%CI：1.17 - 11.97，P = 0.03）独立相关。添加基因型分组后，HAS - BLED评分在出血风险预测方面的性能显著提高（临床相关出血的c统计量从0.60提高到0.64，大出血的c统计量从0.64提高到0.70，P < 0.01）。使用综合鉴别、净重新分类改善和决策曲线分析，HAS - BLED评分加基因型分组在预测任何临床相关出血方面比单独的HAS - BLED评分表现更好。
在预测华法林治疗的AF患者临床相关出血时，基因型与HAS - BLED评分相结合具有递增的预测价值。
