Madken Mohit, Mallick Ranjeeta, Rhodes Emily, Mahdavi Roshanak, Bader Eddeen Anan, Hundemer Gregory L, Kelly Dearbhla M, Karaboyas Angelo, Robinson Bruce, Bieber Brian, Molnar Amber O, Badve Sunil V, Tanuseputro Peter, Knoll Gregory, Sood Manish M
Department of Medicine, The Ottawa Hospital, ON, Canada.
The Ottawa Methods Centre, The Ottawa Hospital, ON, Canada.
Can J Kidney Health Dis. 2023 Jun 22;10:20543581231169610. doi: 10.1177/20543581231169610. eCollection 2023.
Individuals with kidney disease are at a high risk of bleeding and as such tools that identify those at highest risk may aid mitigation strategies.
We set out to develop and validate a prediction equation (BLEED-HD) to identify patients on maintenance hemodialysis at high risk of bleeding.
International prospective cohort study (development); retrospective cohort study (validation).
Development: 15 countries (Dialysis Outcomes and Practice Patterns Study [DOPPS] phase 2-6 from 2002 to 2018); Validation: Ontario, Canada.
Development: 53 147 patients; Validation: 19 318 patients.
Hospitalization for a bleeding event.
Cox proportional hazards models.
Among the DOPPS cohort (mean age, 63.7 years; female, 39.7%), a bleeding event occurred in 2773 patients (5.2%, event rate 32 per 1000 person-years), with a median follow-up of 1.6 (interquartile range [IQR], 0.9-2.1) years. BLEED-HD included 6 variables: age, sex, country, previous gastrointestinal bleeding, prosthetic heart valve, and vitamin K antagonist use. The observed 3-year probability of bleeding by deciles of risk ranged from 2.2% to 10.8%. Model discrimination was low to moderate (c-statistic = 0.65) with excellent calibration (Brier score range = 0.036-0.095). Discrimination and calibration of BLEED-HD were similar in an external validation of 19 318 patients from Ontario, Canada. Compared to existing bleeding scores, BLEED-HD demonstrated better discrimination and calibration (c-statistic: HEMORRHAGE = 0.59, HAS-BLED = 0.59, and ATRIA = 0.57, c-stat difference, net reclassification index [NRI], and integrated discrimination index [IDI] all value <.0001).
Dialysis procedure anticoagulation was not available; validation cohort was considerably older than the development cohort.
In patients on maintenance hemodialysis, BLEED-HD is a simple risk equation that may be more applicable than existing risk tools in predicting the risk of bleeding in this high-risk population.
肾病患者有较高的出血风险，因此识别出血风险最高的患者的工具可能有助于制定缓解策略。
我们旨在开发并验证一种预测方程（BLEED-HD），以识别维持性血液透析患者中的高出血风险患者。
国际前瞻性队列研究（开发阶段）；回顾性队列研究（验证阶段）。
开发阶段：15个国家（2002年至2018年透析结果与实践模式研究[DOPPS]第2-6阶段）；验证阶段：加拿大安大略省。
开发阶段：53147例患者；验证阶段：19318例患者。
因出血事件住院。
Cox比例风险模型。
在DOPPS队列中（平均年龄63.7岁；女性占39.7%），2773例患者发生了出血事件（5.2%，事件发生率为每1000人年32例），中位随访时间为1.6年（四分位间距[IQR]，0.9-2.1年）。BLEED-HD包含6个变量：年龄、性别、国家、既往胃肠道出血、人工心脏瓣膜和维生素K拮抗剂使用情况。按风险十分位数观察到的3年出血概率范围为2.2%至10.8%。模型区分度低至中等（c统计量=0.65），校准良好（Brier评分范围=0.036-0.095）。在对来自加拿大安大略省的19318例患者进行的外部验证中，BLEED-HD的区分度和校准情况相似。与现有的出血评分相比，BLEED-HD表现出更好的区分度和校准（c统计量：HEMORRHAGE=0.59，HAS-BLED=0.59，ATRIA=0.57，c统计量差异、净重新分类指数[NRI]和综合区分指数[IDI]均<0.0001）。
未获取透析过程中的抗凝情况；验证队列比开发队列年龄大得多。
对于维持性血液透析患者，BLEED-HD是一个简单的风险方程，在预测这一高危人群的出血风险方面可能比现有风险工具更适用。
