Low discriminating power of the modified Ottawa VTE risk score in a cohort of patients with cancer from the RIETE registry
Por:
Alatri, A, Mazzotai, L, Font, C, Tafur, A, Valle, R, Marchenas, PJ, Ballaz, A, Tiraferri, E, Font, L and Monreal, M
Publicada:
1 ago 2017
Categoría:
Hematology
Resumen:
Treatment of patients with cancer-associated venous thromboembolism (VTE) remains a major challenge. The modified Ottawa score is a clinical prediction rule evaluating the risk of VTE recurrences during the first six months of anticoagulant treatment in patients with cancer-related VTE. We aimed to validate the Ottawa score using data from the RIETE registry. A total of 11,123 cancer patients with VTE were included in the analysis. According to modified Ottawa score, 2,343 (21 %) were categorised at low risk for VTE recurrences, 4,525 (41 %) at intermediate risk, and 4,255 (38%) at high risk. Overall, 477 episodes of VTE recurrences were recorded during the course of anticoagulant therapy, with an incidence rate for low, intermediate, and high risk groups of 6.88% (95% CI 5.31-8.77), 11.8% (95% CI 10.1-13.6), and 21.3 % (95 % CI 18.8-24.1) patient-years, respectively. Overall mortality had an incidence rate of 21.1 % (95% CI 18.2-24.3), 79.4% (95 % CI: 74.9-84.1), and 134.7 % (95 % CI: 128.3-141.4) patient-years, respectively. The accuracy and discriminating power of the modified Ottawa score for VTE recurrence was modest, with low sensitivity, specificity and positive predictive value, and a C-statistics of 0.58 (95% CI: 0.56-0.61). In our analysis, the modified Ottawa score did not accurately predict VTE recurrence among patients with cancer-associated thrombosis, thus hindering its use in clinical practice. It is time to define a new score including other clinical predictors.
Filiaciones:
Alatri, A:
Lausanne Univ Hosp, Div Angiol, Lausanne, Switzerland
Mazzotai, L:
Lausanne Univ Hosp, Div Angiol, Lausanne, Switzerland
Font, C:
Hosp Clin Barcelona, ICMHO, Barcelona, Spain
Tafur, A:
Northshore Univ HealthSyst, Cardiol Vasc Sect, Dept Med, Evanston, IL USA
Valle, R:
Hosp Sierrallana, Dept Internal Med, Santander, Spain
Marchenas, PJ:
Parc Sanitari St Joan de Deu Hosp Gen, Dept Internal Med & Emergency, Barcelona, Spain
Ballaz, A:
Hosp Galdakao, Dept Pneumol, Vizcaya, Spain
Tiraferri, E:
Osped Infermi, Dept Haemostasis & Thrombosis, Rimini, Italy
Font, L:
Hosp Tortosa Verge de la Cinta, Dept Haematol, Tarragona, Spain
:
Univ Catolica Murcia, Hosp Univ Germans Trias & Pujol Badalona, Dept Internal Med, Murcia, Spain
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