CRUSADE出血风险评分与HAS-BLED评分评估稳定性冠心病患者出血风险的价值比较

Comparison of CRUSADE bleeding risk score and HAS-BLED score to predict hemorrhagic risk in patients with stable coronary artery disease

目的比较CRUSADE出血风险评分和HAS-BLED评分对接受选择性冠状动脉造影(SCAG)的稳定性冠心病(SCAD)患者院内出血风险的预测价值。方法回顾性分析2017年1月至2019年1月于济南市第八人民医院心内科接受选择性冠状动脉造影的402例稳定性冠心病患者的临床资料,观察院内出血事件发生情况。院内出血事件依据出血学术研究会(BARC)提出的出血定义。根据有无出血事件将患者分为出血组(n=31)和未出血组(n=371),其中118例接受经皮冠状动脉介入(PCI)治疗的患者又分为出血组A(n=17)与未出血组B(n=101)两个亚组,对患者进行CRUSADE出血风险评分和HAS-BLED评分。通过比较ROC的AUC,评估两种评分对该类患者院内出血的预测价值。结果出血组年龄大于未出血组,红细胞比容小于未出血组,差异有统计学意义(P<0.05);两组女性占比、体重指数、吸烟史占比、既往史(高血压史、糖尿病史、血管疾病史、冠心病史、脑血管病史)占比、收缩压、舒张压、心率、白细胞计数、血红蛋白水平、红细胞比容、血小板计数、肌酐水平、国际标准化比值(INR)比较差异无统计学意义。出血组HAS-BLED评分明显高于未出血组,差异有统计学意义(P<0.05);两组CRUSADE出血风险评分比较差异无统计学意义;出血组HAS-BLED评分≥3分、CRUSADE出血风险评分>30分占比均明显高于未出血组,差异有统计学意义(P<0.05);两组CRUSADE出血风险评分>40分占比比较差异无统计学意义。接受PCI术的亚组中,出血组A HAS-BLED评分明显高于未出血组B,HAS-BLED评分≥3分占比明显高于未出血组B,差异有统计学意义(P<0.05);两组CRUSADE出血风险评分及CRUSADE出血风险评分>30分、CRUSADE出血风险评分>40分占比比较差异无统计学意义。ROC曲线分析结果显示,HAS-BLED评分的AUC值为0.704(95%CI:0.621~0.786),CRUSADE出血风险评分的AUC值为0.599(95%CI:0.504~0.693),二者比较差异有统计学意义(P<0.05)。接受PCI术的亚组中,HAS-BLED评分的AUC值为0.740(95%CI:0.662~0.818),CRUSADE出血风险评分的AUC值为0.605(95%CI:0.514~0.696),二者比较差异有统计学意义(P<0.05)。结论HAS-BLED评分和CRUSADE出血风险评分对接受SCAG的SCAD患者的出血风险均有预测价值,且HAS-BLED评分对此类患者院内出血风险的预测价值优于CRUSADE评分。

Objective To compare the value of the CRUSADE bleeding risk score and HAS-BLED score in predicting the in-hospital hemorrhage risk in patients with stable coronary artery disease(SCAD)undergoing selective coronary angiography(SCAG).Methods The clinical data of 402 patients with SCAD who undergoing SCAG in the Department of Cardiology,the Eighth People's Hospital of Ji'nan from January 2017 to January 2019 were retrospectively analyzed,observe the occurrence of bleeding events in-hospital.In-hospital bleeding events were defined according to the definition of bleeding proposed by bleeding academic reaearch consortium(BARC).The patients were divided into bleeding group(n=31)and non-bleeding group(n=371)according to the presence or absence of bleeding events,among them,118 patients undergoing percutaneous coronary intervention(PCI)were divided into two subgroups:bleeding group(n=17)and non-bleeding group(n=101),CRUSADE bleeding risk score and HASBLED score were performed on the patients.By comparing the AUC of ROC,the predictive value of the two scores for in-hospital bleeding in these patients was evaluated.Results The age in the bleeding group was older than that in the non-bleeding group,and the hematocrit was smaller than that of the non-bleeding group,the differences were statistically significant(P<0.05).There was no significant difference in female proportion,body mass index,proportion of smoking history,proportion of past history(hypertension history,diabetes history,vascular disease history,coronary heart disease history,cerebrovascular disease history),systolic blood pressure,diastolic blood pressure,heart rate,white blood cell count,hemoglobin level,hematocrit,platelet count,creatinine level and international standardized ratio(INR)between the two groups.The HAS-BLED score in the bleeding group was significantly higher than that in the non-bleeding group(P<0.05);there was no significant difference in CRUSADE bleeding risk score between the two groups;the proportion of HAS-BLED score≥3 scores and CRUSADE bleeding risk score>30 scores in the bleeding group were significantly higher than those in the non-bleeding group,and the differences were statistically significant(P<0.05);there was no significant difference in the proportion of CRUSADE bleeding risk score>40 scores between the two groups.In the subgroup of PCI,the HAS-BLED scores in the bleeding group A was significantly higher than that in the non-bleeding group B,and the proportion of HAS-BLED scores≥3 scores was significantly higher than that in the non-bleeding group B,the differences were statistically significant(P<0.05);there was no significant difference in CRUSADE bleeding risk scores and the proportion of CRUSADE bleeding risk score>30 scores and CRUSADE bleeding risk score>40 scores between the two groups.Results of ROC curve analysis showed that the AUC value of HAS-BLED score was 0.704(95%CI:0.621-0.786),and the AUC value of CRUSADE bleeding risk score was 0.599(95%CI:0.504-0.693),the difference was statistically significant(P<0.05).In the subgroup receiving PCI,the AUC value of HAS-BLED score was 0.740(95%CI:0.662-0.818),and the AUC value of CRUSADE bleeding risk score was 0.605(95%CI:0.514-0.696),the difference was statistically significant(P<0.05).Conclusion Both the score of HAS-BLED scores and CRUDASE bleeding risk score are valuable on the assessment of in-hospital hemorrhage in patients with SCAD undergoing SCAG,the predictive value of HAS-BLED score for the risk of in-hospital bleeding in such patients was better than that of CRUSADE score.