External validation of the ADA score for predicting thrombosis among acutely ill hospitalized medical patients from the APEX Trial.
J Thromb Thrombolysis
; 55(2): 211-221, 2023 Feb.
Article
Dans Anglais
| MEDLINE | ID: covidwho-2254815
ABSTRACT
The ADA (Age-D-dimer-Albumin) score was developed to identify hospitalized patients at an increased risk for thrombosis in the coronavirus infectious disease-19 (COVID-19) setting. The study aimed to validate the ADA score for predicting thrombosis in a non-COVID-19 medically ill population from the APEX trial. The APEX trial was a multinational, randomized trial that evaluated the efficacy and safety of betrixaban vs. enoxaparin among acutely ill hospitalized patients at risk for venous thromboembolism. The study endpoints included the composite of arterial or venous thrombosis and its components. Metrics of model calibration and discrimination were computed for assessing the performance of the ADA score as compared to the IMPROVE score, a well-validated VTE risk assessment model. Among 7,119 medical inpatients, 209 (2.9%) had a thrombosis event up to 77 days of follow-up. The ADA score demonstrated good calibration for both arterial and venous thrombosis, whereas the IMPROVE score had adequate calibration for venous thrombosis (p > 0.05 from the Hosmer-Lemeshow test). For discriminating arterial and venous thrombosis, there was no significant difference between the ADA vs. IMPROVE score (c statistic = 0.620 [95% CI 0.582 to 0.657] vs. 0.590 [95% CI 0.556 to 0.624]; ∆ c statistic = 0.030 [95% CI -0.022 to 0.081]; p = 0.255). Similarly, for discriminating arterial thrombosis, there was no significant difference between the ADA vs. IMPROVE score (c statistic = 0.582 [95% CI 0.534 to 0.629] vs. 0.609 [95% CI 0.564 to 0.653]; ∆ c statistic = -0.027 [95% CI -0.091 to 0.036]; p = 0.397). For discriminating venous thrombosis, the ADA score was modestly superior to the IMPROVE score (c statistic = 0.664 [95% CI 0.607 to 0.722] vs. 0.573 [95% CI 0.521 to 0.624]; ∆ c statistic = 0.091 [95% CI 0.011 to 0.172]; p = 0.026). The ADA score had a higher sensitivity (0.579 [95% CI 0.512 to 0.646]; vs. 0.440 [95% CI 0.373 to 0.507]) but lower specificity (0.625 [95% CI 0.614 to 0.637] vs. 0.747 [95% CI 0.737 to 0.758]) than the IMPROVE score for predicting thrombosis. Among acutely ill hospitalized medical patients enrolled in the APEX trial, the ADA score demonstrated good calibration but suboptimal discrimination for predicting thrombosis. The findings support the use of either the ADA or IMPROVE score for thrombosis risk assessment. The applicability of the ADA score to non-COVID-19 populations warrants further research.Clinical Trial Registration http//www.clinicaltrials.gov . Unique identifier NCT01583218.
Mots clés
Texte intégral:
Disponible
Collection:
Bases de données internationales
Base de données:
MEDLINE
Sujet Principal:
Thrombose veineuse
/
Thromboembolisme veineux
/
COVID-19
Type d'étude:
Étude de cohorte
/
Étude diagnostique
/
Études expérimentales
/
Étude pronostique
/
Essai contrôlé randomisé
Les sujets:
Covid long
Limites du sujet:
Humains
langue:
Anglais
Revue:
J Thromb Thrombolysis
Thème du journal:
Maladies vasculaires
Année:
2023
Type de document:
Article
Pays d'affiliation:
S11239-022-02757-8
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