Predictive ability of scores for bleeding risk in heart disease outpatients on warfarin in Brazil
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Publication Date: | 2018 |
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Format: | Article |
Language: | eng |
Source: | Repositório Institucional da UFMG |
Download full: | http://hdl.handle.net/1843/47158 |
Summary: | Introduction Bleeding is a common complication in patients taking warfarin. We sought to compare the performance of nine prediction models for bleeding risk in warfarin-treated Brazilian outpatients. Methods The dataset was derived from a clinical trial conducted to evaluate the efficacy of an anticoagulation clinic at a public hospital in Brazil. Overall, 280 heart disease outpatients taking warfarin were enrolled. The prediction models OBRI, Kuijer et al., Kearon et al., HEMORR2HAGES, Shireman et al., RIETE, HAS-BLED, ATRIA and ORBIT were compared to evaluate the overall model performance by Nagelkerke’s R2 estimation, discriminative ability based on the concordance (c) statistic and calibration based on the Hosmer-Lemeshow goodness-of-fit statistic. The primary outcomes were the first episodes of major bleeding, clinically relevant non-major bleeding and non-major bleeding events within 12 months of follow-up. Results Major bleeding occurred in 14 participants (5.0%), clinically relevant non-major bleeding in 29 (10.4%), non-major bleeding in 154 (55.0%) and no bleeding at all in 115 (41.1%). Most participants with major bleeding had their risk misclassified. All the models showed low overall performance (R2 0.6–9.3%) and poor discriminative ability for predicting major bleeding (c <0.7), except Shireman et al. and ORBIT models (c 0.725 and 0.719, respectively). Results were not better for predicting other bleedings. All models showed good calibration for major bleeding. Conclusions Only two models (Shireman et al. and ORBIT) showed at least acceptable performance in the prediction of major bleeding in warfarin-treated Brazilian patients. Accurate models warrant further investigation to be used in similar populations. |
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2022-11-10T21:38:57Z2022-11-10T21:38:57Z2018131010.1371/journal.pone.02059701932-6203http://hdl.handle.net/1843/47158Introduction Bleeding is a common complication in patients taking warfarin. We sought to compare the performance of nine prediction models for bleeding risk in warfarin-treated Brazilian outpatients. Methods The dataset was derived from a clinical trial conducted to evaluate the efficacy of an anticoagulation clinic at a public hospital in Brazil. Overall, 280 heart disease outpatients taking warfarin were enrolled. The prediction models OBRI, Kuijer et al., Kearon et al., HEMORR2HAGES, Shireman et al., RIETE, HAS-BLED, ATRIA and ORBIT were compared to evaluate the overall model performance by Nagelkerke’s R2 estimation, discriminative ability based on the concordance (c) statistic and calibration based on the Hosmer-Lemeshow goodness-of-fit statistic. The primary outcomes were the first episodes of major bleeding, clinically relevant non-major bleeding and non-major bleeding events within 12 months of follow-up. Results Major bleeding occurred in 14 participants (5.0%), clinically relevant non-major bleeding in 29 (10.4%), non-major bleeding in 154 (55.0%) and no bleeding at all in 115 (41.1%). Most participants with major bleeding had their risk misclassified. All the models showed low overall performance (R2 0.6–9.3%) and poor discriminative ability for predicting major bleeding (c <0.7), except Shireman et al. and ORBIT models (c 0.725 and 0.719, respectively). Results were not better for predicting other bleedings. All models showed good calibration for major bleeding. Conclusions Only two models (Shireman et al. and ORBIT) showed at least acceptable performance in the prediction of major bleeding in warfarin-treated Brazilian patients. Accurate models warrant further investigation to be used in similar populations.Introdução O sangramento é uma complicação comum em pacientes que tomam varfarina. Buscamos comparar o desempenho de nove modelos de predição de risco de sangramento em pacientes ambulatoriais brasileiros tratados com varfarina. Métodos O conjunto de dados foi derivado de um ensaio clínico realizado para avaliar a eficácia de uma clínica de anticoagulação em um hospital público no Brasil. No geral, 280 pacientes ambulatoriais com doenças cardíacas em uso de varfarina foram inscritos. Os modelos de predição OBRI, Kuijer et al., Kearon et al., HEMORR2HAGES, Shireman et al., RIETE, HAS-BLED, ATRIA e ORBIT foram comparados para avaliar o desempenho global do modelo pela estimativa R2 de Nagelkerke, capacidade discriminativa baseada na concordância (c) estatística e calibração com base na estatística de ajuste de Hosmer-Lemeshow. Os desfechos primários foram os primeiros episódios de sangramento maior, sangramento não maior clinicamente relevante e eventos hemorrágicos não maiores dentro de 12 meses de acompanhamento. Resultados Sangramento maior ocorreu em 14 participantes (5,0%), sangramento não maior clinicamente relevante em 29 (10,4%), sangramento não maior em 154 (55,0%) e nenhum sangramento em 115 (41,1%). A maioria dos participantes com sangramento maior teve seu risco classificado erroneamente. Todos os modelos mostraram baixo desempenho geral (R2 0,6–9,3%) e baixa capacidade discriminativa para prever sangramento maior (c <0,7), exceto Shireman et al. e modelos ORBIT (c 0,725 e 0,719, respectivamente). Os resultados não foram melhores para prever outros sangramentos. Todos os modelos apresentaram boa calibração para sangramento maior. Conclusões Apenas dois modelos (Shireman et al. e ORBIT) apresentaram desempenho pelo menos aceitável na predição de sangramento maior em pacientes brasileiros tratados com varfarina. Modelos precisos garantem mais investigações para serem usados em populações semelhantes.engUniversidade Federal de Minas GeraisUFMGBrasilFAR - DEPARTAMENTO DE PRODUTOS FARMACÊUTICOSMED - DEPARTAMENTO DE CLÍNICA MÉDICAPlos OneSangramentoVarfarinaPredictive ability of scores for bleeding risk in heart disease outpatients on warfarin in BrazilCapacidade preditiva dos escores de risco de sangramento em cardiopatas ambulatoriais em uso de varfarina no Brasilinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0205970João Antônio de Queiroz OliveiraAntonio Luiz Pinho RibeiroDaniel Dias RibeiroVandack NobreManoel Otávio da Costa RochaMaria Auxiliadora Parreiras Martinsapplication/pdfinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMGLICENSELicense.txtLicense.txttext/plain; charset=utf-82042https://repositorio.ufmg.br/bitstream/1843/47158/1/License.txtfa505098d172de0bc8864fc1287ffe22MD51ORIGINAL2018_Predictive ability of scores for bleeding risk in heart disease outpatients on warfarin in brazil.pdf2018_Predictive ability of scores for bleeding risk in heart disease outpatients on warfarin in brazil.pdfapplication/pdf722720https://repositorio.ufmg.br/bitstream/1843/47158/2/2018_Predictive%20ability%20of%20scores%20for%20bleeding%20risk%20in%20heart%20disease%20outpatients%20on%20warfarin%20in%20brazil.pdf363d09bbe8d234c6950bc803d79c77f4MD521843/471582022-11-10 18:38:57.512oai:repositorio.ufmg.br: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Repositório de PublicaçõesPUBhttps://repositorio.ufmg.br/oaiopendoar:2022-11-10T21:38:57Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false |
dc.title.pt_BR.fl_str_mv |
Predictive ability of scores for bleeding risk in heart disease outpatients on warfarin in Brazil |
dc.title.alternative.pt_BR.fl_str_mv |
Capacidade preditiva dos escores de risco de sangramento em cardiopatas ambulatoriais em uso de varfarina no Brasil |
title |
Predictive ability of scores for bleeding risk in heart disease outpatients on warfarin in Brazil |
spellingShingle |
Predictive ability of scores for bleeding risk in heart disease outpatients on warfarin in Brazil João Antônio de Queiroz Oliveira Sangramento Varfarina |
title_short |
Predictive ability of scores for bleeding risk in heart disease outpatients on warfarin in Brazil |
title_full |
Predictive ability of scores for bleeding risk in heart disease outpatients on warfarin in Brazil |
title_fullStr |
Predictive ability of scores for bleeding risk in heart disease outpatients on warfarin in Brazil |
title_full_unstemmed |
Predictive ability of scores for bleeding risk in heart disease outpatients on warfarin in Brazil |
title_sort |
Predictive ability of scores for bleeding risk in heart disease outpatients on warfarin in Brazil |
author |
João Antônio de Queiroz Oliveira |
author_facet |
João Antônio de Queiroz Oliveira Antonio Luiz Pinho Ribeiro Daniel Dias Ribeiro Vandack Nobre Manoel Otávio da Costa Rocha Maria Auxiliadora Parreiras Martins |
author_role |
author |
author2 |
Antonio Luiz Pinho Ribeiro Daniel Dias Ribeiro Vandack Nobre Manoel Otávio da Costa Rocha Maria Auxiliadora Parreiras Martins |
author2_role |
author author author author author |
dc.contributor.author.fl_str_mv |
João Antônio de Queiroz Oliveira Antonio Luiz Pinho Ribeiro Daniel Dias Ribeiro Vandack Nobre Manoel Otávio da Costa Rocha Maria Auxiliadora Parreiras Martins |
dc.subject.other.pt_BR.fl_str_mv |
Sangramento Varfarina |
topic |
Sangramento Varfarina |
description |
Introduction Bleeding is a common complication in patients taking warfarin. We sought to compare the performance of nine prediction models for bleeding risk in warfarin-treated Brazilian outpatients. Methods The dataset was derived from a clinical trial conducted to evaluate the efficacy of an anticoagulation clinic at a public hospital in Brazil. Overall, 280 heart disease outpatients taking warfarin were enrolled. The prediction models OBRI, Kuijer et al., Kearon et al., HEMORR2HAGES, Shireman et al., RIETE, HAS-BLED, ATRIA and ORBIT were compared to evaluate the overall model performance by Nagelkerke’s R2 estimation, discriminative ability based on the concordance (c) statistic and calibration based on the Hosmer-Lemeshow goodness-of-fit statistic. The primary outcomes were the first episodes of major bleeding, clinically relevant non-major bleeding and non-major bleeding events within 12 months of follow-up. Results Major bleeding occurred in 14 participants (5.0%), clinically relevant non-major bleeding in 29 (10.4%), non-major bleeding in 154 (55.0%) and no bleeding at all in 115 (41.1%). Most participants with major bleeding had their risk misclassified. All the models showed low overall performance (R2 0.6–9.3%) and poor discriminative ability for predicting major bleeding (c <0.7), except Shireman et al. and ORBIT models (c 0.725 and 0.719, respectively). Results were not better for predicting other bleedings. All models showed good calibration for major bleeding. Conclusions Only two models (Shireman et al. and ORBIT) showed at least acceptable performance in the prediction of major bleeding in warfarin-treated Brazilian patients. Accurate models warrant further investigation to be used in similar populations. |
publishDate |
2018 |
dc.date.issued.fl_str_mv |
2018 |
dc.date.accessioned.fl_str_mv |
2022-11-10T21:38:57Z |
dc.date.available.fl_str_mv |
2022-11-10T21:38:57Z |
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info:eu-repo/semantics/article |
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article |
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http://hdl.handle.net/1843/47158 |
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10.1371/journal.pone.0205970 |
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1932-6203 |
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10.1371/journal.pone.0205970 1932-6203 |
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Brasil |
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FAR - DEPARTAMENTO DE PRODUTOS FARMACÊUTICOS MED - DEPARTAMENTO DE CLÍNICA MÉDICA |
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Universidade Federal de Minas Gerais |
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