Prediction of very early major bleeding risk in acute pulmonary embolism: an independent external validation of the PE-SARD Bleeding Score.

Villiger, Rahel; Méan, Marie; Stalder, Odile; Limacher, Andreas; Rodondi, Nicolas; Righini, Marc; Aujesky, Drahomir (2023). Prediction of very early major bleeding risk in acute pulmonary embolism: an independent external validation of the PE-SARD Bleeding Score. Journal of thrombosis and haemostasis, 21(10), pp. 2884-2893. Elsevier 10.1016/j.jtha.2023.04.025

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BACKGROUND

The PE-SARD Bleeding Score was derived to predict very early major bleeding (MB) in patients with acute pulmonary embolism (PE). Before adoption into practice the score requires external validation in different populations.

OBJECTIVE

We independently validated the PE-SARD in a prospective multicenter Swiss cohort of 687 patients aged ≥65 years with acute PE.

METHODS

The PE-SARD uses 3 variables (syncope, anemia, renal dysfunction) to classify patients into 3 categories of increasing bleeding risk. The outcomes were very early MB at 7 days (primary) and MB at later time points (secondary). We calculated the PE-SARD for each patient and the proportion of patients classified as low, intermediate, and high risk. To assess discrimination and calibration, we calculated the area under the receiver operating characteristic (ROC) curve and the Hosmer-Lemeshow goodness-of-fit test, respectively.

RESULTS

The prevalence of MB was 2.0% (14/687) at 7 days and 14.0% (96/687) after a median follow-up of 30 months. The PE-SARD classified 40.2%, 42.2%, and 17.6% of patients as low, intermediate, and high risk for MB, respectively. The frequency of observed very early MB at 7 days was 1.8% in low-, 2.1% in intermediate-, and 2.5% in high-risk patients. The area under the ROC curve was 0.52 (95%CI 0.48-0.56) at 7 days and increased to 0.60 (95%CI 0.56-0.64) at the end of follow-up. Score calibration was adequate (P>0.05) over the entire follow-up.

CONCLUSION

In our independent validation, the PE-SARD did not accurately predict very early MB and may not be transportable to older patients with PE.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)
04 Faculty of Medicine > Pre-clinic Human Medicine > Department of Clinical Research (DCR)
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine

UniBE Contributor:

Villiger, Rahel Andrea, Stalder, Odile, Limacher, Andreas, Rodondi, Nicolas, Aujesky, Drahomir

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1538-7836

Publisher:

Elsevier

Funders:

[4] Swiss National Science Foundation

Language:

English

Submitter:

Pubmed Import

Date Deposited:

08 May 2023 15:23

Last Modified:

20 Feb 2024 14:15

Publisher DOI:

10.1016/j.jtha.2023.04.025

PubMed ID:

37149148

Uncontrolled Keywords:

Anticoagulants PE-SARD Bleeding Score bleeding pulmonary embolism validation

BORIS DOI:

10.48350/182373

URI:

https://boris.unibe.ch/id/eprint/182373

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