四种评分系统对服用达比加群的心房颤动患者出血风险的预测价值比较

Predictive value of four score systems on the bleeding risk in atrial fibrillation patients treated with dabigatran

目的比较HAS-BLED、HEMORR2HAGES、ATRIA及ORBIT 4种出血风险评分系统对我国服用达比加群治疗的非瓣膜性心房颤动(nonvalvular atrial fibrillation,NVAF)患者出血风险的预测价值。方法选取2015年2月至2017年12月在全国12个中心开展的前瞻性队列研究达比加群治疗安全性监测系统中,HAS-BLED、HEMORR2HAGES、ATRIA及ORBIT 4种出血风险评分系统及随访数据完整的942例NVAF患者。研究终点为随访6个月发生的出血事件。通过Cox比例风险回归模型分析4种出血风险评分系统与出血事件的相关性,采用受试者工作特征曲线下面积(AUC)评估各评分系统对出血风险的预测价值。结果942例患者年龄为(65.3±11.2)岁,男性542例(57.5%)。随访期间共有93例(9.9%)患者发生出血事件,其中89例(9.4%)轻微出血事件,4例(0.4%)大出血事件。HAS-BLED评分系统分级为高危的患者比低危患者出血风险高1.87倍(HR=2.87,95%CI∶1.26~6.51,P=0.012),其他评分系统的分级与出血风险的关系差异无统计学意义(P均>0.05)。HAS-BLED、HEMORR2HAGES、ATRIA、ORBIT出血风险评分系统的AUC(95%CI)分别为0.558(0.525~0.590)、0.520(0.487~0.553)、0.513(0.480~0.545)、0.523(0.490~0.555),AUC均≤0.700,预测价值较低。结论在我国服用达比加群的NVAF患者中,HAS-BLED评分系统对出血风险的预测价值优于HEMORR2HAGES、ATRIA和ORBIT评分系统,但其预测价值仍较低。

Objective To compare the predictive value of HAS-BLED,HEMORR,HAGES,ATRIA and ORBIT scores on the bleeding risk in nonvalvular atrial fibrillation(NVAF)patients treated with dabigatran.Methods Data of 942 NVAF patients participating a non-interventional prospective study of anticoagulant therapy with dabigatran,which was conducted in 12 centers from February 2015 to December 2017 in China,were analyzed.Comnplete HAS-BLED HEMORR,HAGES,ATRIA and ORBIT bleeding risk scores data and follow-up data were available in the enrolled patients.The endpoint of the study was bleeding events occurred during a 6 months follow-up.Cox proportional hazards models were constructed to analyze the associations between HAS BLED,HEMORR,HAGES,ATRIA and ORBIT scores and risk of bleeding,and the area under the curve[AUC]of receiver operating characteristics curves(ROC)of each score was used to set the predictive value for bleeding risk.Results Among the 942 patients,the mean age was(65.3+11.2)years old,542(57.5%)were males.A total of 93(9.9%)bleeding events occurred during follow up,89(9.4%)events were minor bleeding,and 4(0.4%)events were major bleeding.Patients with a high-risk HAS-BLED score had a 1.87-fold increased risk of bleeding compared with low-risk patients(HR=2.87,95%CI:1.26-6.51,P=0.012).There was no statistically significant difference between low-medium-high-risk grading in other scoring systems and bleeding risk(all P>0.05).The AUC(95%CN)of HAS-BLED,HEMORR,HAGES,ATRIA and ORBIT bleeding risk scores were 0.558(0.525-0.590),0.520(0.487-0.553),0.513(0.480-0.545),0.523(0.490-0.555),respectively.The AUC of all bleeding score systems were of≤0.700.Conclusion Among the NVAF patients taking dabigatran in China,the HAS-BLED bleeding risk score is superior to other 3 bleeding risk score on predicting the bleeding risk in these patients,but its predictive value is still relatively low.