Ruiz-Artacho Pedro, Olid Velilla Mónica, Beddar Chaib Fahd, Lecumberri Ramón, Jiménez David, Hernández Castells Lourdes, Alonso Valle Héctor, Pedraza García Jorge, Sendín Martín Vanesa, Cárdenas Bravo Línder, Muriel Alfonso, Jiménez Hernández Sònia
Internal Medicine Department, Clínica Universidad de Navarra, Madrid, Spain; Interdisciplinar Teragnosis and Radiosomics Research Group (INTRA-Madrid), Universidad de Navarra, Madrid, Spain; CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain.
Internal Medicine Department, Clínica Universidad de Navarra, Madrid, Spain.
Am J Med. 2025 Aug;138(8):1150-1158.e1. doi: 10.1016/j.amjmed.2025.03.027. Epub 2025 Mar 29.
The optimal risk assessment model (RAM) for venous thromboembolism in hospitalized medical patients remains controversial. This study aimed to assess the prognostic performance of Padua, International Medical Prevention Registry on Venous Thromboembolism (IMPROVE), and National Institute for Health and Care Excellence (NICE) guidelines' RAMs.
A multicenter prospective observational study was conducted in 15 Spanish hospitals, monitoring consecutive medical inpatients for symptomatic venous thromboembolism over a 90-day follow-up period. The discriminative performance was evaluated using time-to-event analyses and competing risk models accounting for nonvenous thromboembolism-related mortality. Sensitivity, specificity, and area under the receiver operating characteristic curve were calculated to assess predictive accuracy.
Among 1273 patients, the 90-day cumulative venous thromboembolism incidence was 1.0%. After adjusting for pharmacological thromboprophylaxis, high-risk patients did not exhibit a significantly increased venous thromboembolism risk compared to low-risk patients according to Padua (aSHR 5.71; 95% confidence intervals [CI] 0.70-46.86), IMPROVE (aSHR 3.72; 95% CI 1.00-13.87), and NICE RAM (aSHR 0.97; 95% CI 0.30-3.18). Padua had the highest sensitivity (92.3% [95% CI, 62.1%-99.6%]) but lowest specificity (32.3% [95% CI, 29.7%-35.0%]), whereas IMPROVE exhibited the highest specificity (52.9% [95% CI, 50.1%-55.7%]) with moderate sensitivity (76.9% [95% CI, 46.0%-93.8%]). Discriminative performance was suboptimal for all RAMs (area under the curve: Padua 62.3%, IMPROVE 64.9%, NICE 50.1%).
Padua, IMPROVE, and NICE RAMs demonstrated poor predictive accuracy in stratifying venous thromboembolism risk among hospitalized medical patients. These findings underscore the need for more precise, dynamic RAMs tailored to real-world clinical settings to enhance thromboprophylaxis and patient outcomes.
住院内科患者静脉血栓栓塞的最佳风险评估模型（RAM）仍存在争议。本研究旨在评估帕多瓦（Padua）、国际静脉血栓栓塞症医学预防注册研究（IMPROVE）和英国国家卫生与临床优化研究所（NICE）指南的风险评估模型的预后性能。
在15家西班牙医院进行了一项多中心前瞻性观察性研究，对连续入住的内科患者进行为期90天的随访，监测症状性静脉血栓栓塞情况。使用事件发生时间分析和考虑非静脉血栓栓塞相关死亡率的竞争风险模型评估判别性能。计算敏感性、特异性和受试者工作特征曲线下面积以评估预测准确性。
在1273例患者中，90天累积静脉血栓栓塞发生率为1.0%。在调整药物性血栓预防措施后，根据帕多瓦模型（调整后风险比5.71；95%置信区间[CI]0.70 - 46.86）、IMPROVE模型（调整后风险比3.72；95%CI 1.00 - 13.87）和NICE风险评估模型（调整后风险比0.97；95%CI 0.30 - 3.18），高危患者与低危患者相比，静脉血栓栓塞风险并未显著增加。帕多瓦模型敏感性最高（92.3%[95%CI，62.1% - 99.6%]）但特异性最低（32.3%[95%CI，29.7% - 35.0%]），而IMPROVE模型特异性最高（52.9%[95%CI，50.1% - 55.7%]），敏感性中等（76.9%[95%CI，46.0% - 93.8%]）。所有风险评估模型的判别性能均欠佳（曲线下面积：帕多瓦模型62.3%，IMPROVE模型64.9%，NICE模型50.1%）。
帕多瓦、IMPROVE和NICE风险评估模型在对住院内科患者静脉血栓栓塞风险分层时预测准确性较差。这些发现强调需要针对现实临床环境制定更精确、动态的风险评估模型，以加强血栓预防并改善患者预后。
