Dataset Information

The relative risk of bleeding after medical hospitalization: the medical inpatient thrombosis and hemorrhage study.

ABSTRACT:

Background

Clinically relevant bleeding risk in discharged medical patients is underestimated and leads to rehospitalization, morbidity, and mortality. Studies assessing this risk are lacking.

Objective

The aim of this study was to develop and validate a computable phenotype for clinically relevant bleeding using electronic health record (EHR) data and quantify the relative and absolute risks of this bleeding after medical hospitalization.

Methods

We conducted an observational cohort study of people receiving their primary care at sites affiliated with an academic medical center in northwest Vermont, United States. We developed a computable phenotype using EHR data (diagnosis codes, procedure codes, laboratory, and transfusion data) and validated it by manual chart review. Cox proportional hazard models with hospitalization modeled as a time-varying covariate were used to estimate clinically relevant bleeding risk.

Results

The computable phenotype had a positive predictive value of 80% and a negative predictive value of 99%. The bleeding rate in individuals with no medical hospitalizations in the past 3 months was 2.9 per 1000 person-years versus 98.9 per 1000 person-years in those who were discharged in the past 3 months. This translates into a hazard ratio (95% CI) of clinically relevant bleeding of 22.9 (18.9, 27.7), 13.0 (10.0, 16.9), and 6.8 (4.7, 9.8) over the first, second, and third months after discharge, respectively.

Conclusion

We developed and validated a computable phenotype for clinically relevant bleeding and determined its relative and absolute risk in the 3 months after medical hospitalization discharge. The high rates of bleeding observed underscore the clinical importance of capturing and further studying bleeding after medical discharge.

SUBMITTER: Gergi M

PROVIDER: S-EPMC10044469 | biostudies-literature | 2023 Mar

REPOSITORIES: biostudies-literature

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Publications

The relative risk of bleeding after medical hospitalization: the medical inpatient thrombosis and hemorrhage study.

Gergi Mansour M Wilkinson Katherine K Koh Insu I Munger Jordan J Al-Samkari Hanny H Smith Nicholas L NL Roetker Nicholas S NS Plante Timothy B TB Cushman Mary M Repp Allen B AB Holmes Chris E CE Zakai Neil A NA

Journal of thrombosis and haemostasis : JTH 20221222 3

<h4>Background</h4>Clinically relevant bleeding risk in discharged medical patients is underestimated and leads to rehospitalization, morbidity, and mortality. Studies assessing this risk are lacking.<h4>Objective</h4>The aim of this study was to develop and validate a computable phenotype for clinically relevant bleeding using electronic health record (EHR) data and quantify the relative and absolute risks of this bleeding after medical hospitalization.<h4>Methods</h4>We conducted an observatio ...[more]

PMID: 36696219

Similar Datasets

Project description:BackgroundVenous thromboembolism (VTE) prophylaxis remains suboptimal in China due to the bleeding risk associated with pharmacologic prophylaxis. We used data from the DissolVE-2 study to report the risk factors for bleeding and validated the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) bleeding risk score (BRS).MethodsIn-hospital major bleeding incidence in medical patients from the DissolVE-2 study were assessed by Kaplan-Meier method. Risk factors associated with clinically relevant bleeding (CRB) were analysed using Cox regression model. Sensitivity, specificity, positive predictive value, negative predictive value and receiver-operating characteristic (ROC) curve was used to compute the diagnostic accuracy of IMPROVE BRS in the study cohort.FindingsOf the 6623 medical patients, 5076 patients with all relevant clinical details were included for the validation cohort. Overall, 127 CRB events (38 major and 89 clinically relevant non-major bleeding events) occurred in this cohort, with a cumulative incidence rate of 2.6% (95% confidence interval [CI], 2.3-3.4). Application of IMPROVE BRS revealed significantly higher hazards of CRB (hazard ratio [HR]: 7.17, 95% CI, 5.05-10.18) and major bleeding (HR: 13.95, 95% CI, 7.28-26.73) in patients with IMPROVE BRS ≥7. Comparison of predictive parameters revealed higher sensitivity (44.1 vs 35.9) and positive predictive value (10.9 vs 2.6) for CRB in our study than the IMPROVE study, which was substantiated by the area under the curve (0.73, p<0.0001) from the ROC curve analysis.InterpretationIMPROVE BRS is a simple model for estimating bleeding risk in Chinese medical patients and could be used in conjunction with VTE risk assessment models to decide prophylactic treatment for VTE.FundingThis study and the additional data analysis were funded by Sanofi (Beijing) Pharmaceutical Co, Ltd by the Fund of The National Key Research and Development Program of China [Grant 2016YFC0905600] and by CAMS Innovation Fund for Medical Sciences (CIFMS) (No.2018-I2M-1-003).

Dataset Information

The relative risk of bleeding after medical hospitalization: the medical inpatient thrombosis and hemorrhage study.

Background

Objective

Methods

Results

Conclusion

Publications

The relative risk of bleeding after medical hospitalization: the medical inpatient thrombosis and hemorrhage study.

Similar Datasets

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