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:	Pablo Demelo-Rodriguez, Francisco Galeano-Valle, Lucía Ordieres-Ortega, Carmine Siniscalchi, Mar Martín Del Pozo, Ángeles Fidalgo, Aída Gil-Díaz, José Luis Lobo, Cristina De Ancos, Manuel Monreal, For the RIETE-Bleeding Investigators
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	anticoagulants COVID-19 VTE prophylaxis bleeding risk prognosis Microbiology QR1-502
Acceso en línea:	https://doaj.org/article/394d127da37044b1b479f81c54ab2839
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spelling	oai:doaj.org-article:394d127da37044b1b479f81c54ab28392021-11-25T19:14:04ZValidation of a Prognostic Score to Identify Hospitalized Patients with COVID-19 at Increased Risk for Bleeding10.3390/v131122781999-4915https://doaj.org/article/394d127da37044b1b479f81c54ab28392021-11-01T00:00:00Zhttps://www.mdpi.com/1999-4915/13/11/2278https://doaj.org/toc/1999-4915Introduction: 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.Pablo Demelo-RodriguezFrancisco Galeano-ValleLucía Ordieres-OrtegaCarmine SiniscalchiMar Martín Del PozoÁngeles FidalgoAída Gil-DíazJosé Luis LoboCristina De AncosManuel MonrealFor the RIETE-Bleeding InvestigatorsMDPI AGarticleanticoagulantsCOVID-19VTE prophylaxisbleeding riskprognosisMicrobiologyQR1-502ENViruses, Vol 13, Iss 2278, p 2278 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	anticoagulants COVID-19 VTE prophylaxis bleeding risk prognosis Microbiology QR1-502
spellingShingle	anticoagulants COVID-19 VTE prophylaxis bleeding risk prognosis Microbiology QR1-502 Pablo Demelo-Rodriguez Francisco Galeano-Valle Lucía Ordieres-Ortega Carmine Siniscalchi Mar Martín Del Pozo Ángeles Fidalgo Aída Gil-Díaz José Luis Lobo Cristina De Ancos Manuel Monreal For the RIETE-Bleeding Investigators Validation of a Prognostic Score to Identify Hospitalized Patients with COVID-19 at Increased Risk for Bleeding
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.
format	article
author	Pablo Demelo-Rodriguez Francisco Galeano-Valle Lucía Ordieres-Ortega Carmine Siniscalchi Mar Martín Del Pozo Ángeles Fidalgo Aída Gil-Díaz José Luis Lobo Cristina De Ancos Manuel Monreal For the RIETE-Bleeding Investigators
author_facet	Pablo Demelo-Rodriguez Francisco Galeano-Valle Lucía Ordieres-Ortega Carmine Siniscalchi Mar Martín Del Pozo Ángeles Fidalgo Aída Gil-Díaz José Luis Lobo Cristina De Ancos Manuel Monreal For the RIETE-Bleeding Investigators
author_sort	Pablo Demelo-Rodriguez
title	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_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_sort	validation of a prognostic score to identify hospitalized patients with covid-19 at increased risk for bleeding
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/394d127da37044b1b479f81c54ab2839
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Validation of a Prognostic Score to Identify Hospitalized Patients with COVID-19 at Increased Risk for Bleeding

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