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Development and validation of risk prediction model for venous thromboembolism in postpartum women: multinational cohort study

机译:产后女性静脉血栓栓塞风险预测模型的开发和验证:多国队列研究

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摘要

Objective: To develop and validate a risk prediction model for venous thromboembolism in the first six weeks after delivery (early postpartum).ududDesign: Cohort study.ududSetting: Records from England based Clinical Practice Research Datalink (CPRD) linked to Hospital Episode Statistics (HES) and data from Sweden based registry.ududParticipants: All pregnant women registered with CPRD-HES linked data between 1997 and 2014 and Swedish medical birth registry between 2005 and 2011 with postpartum follow-up.ududMain outcome measure: Multivariable logistic regression analysis was used to develop a risk prediction model for postpartum venous thromboembolism based on the English data, which was externally validated in the Swedish data.ududResults: 433 353 deliveries were identified in the English cohort and 662 387 in the Swedish cohort. The absolute rate of venous thromboembolism was 7.2 per 10 000 deliveries in the English cohort and 7.9 per 10 000 in the Swedish cohort. Emergency caesarean delivery, stillbirth, varicose veins, pre-eclampsia/eclampsia, postpartum infection, and comorbidities were the strongest predictors of venous thromboembolism in the final multivariable model. Discrimination of the model was similar in both cohorts, with a C statistic above 0.70, with excellent calibration of observed and predicted risks. The model identified more venous thromboembolism events than the existing national English (sensitivity 68% v 63%) and Swedish guidelines (30% v 21%) at similar thresholds.ududConclusion: A new prediction model that quantifies absolute risk of postpartum venous thromboembolism has been developed and externally validated. It is based on clinical variables that are available in many developed countries at the point of delivery and could serve as the basis for real time decisions on obstetric thromboprophylaxis.%U http://www.bmj.com/content/bmj/355/bmj.i6253.full.pdf
机译:目的:在分娩后的前六周(产后早期)开发和验证静脉血栓栓塞的风险预测模型。 ud ud设计:队列研究。 ud ud设置:来自英格兰的临床实践研究数据链接(CPRD)的记录已链接 ud ud参与者:所有在CPRD-HES上注册的孕妇均将1997年至2014年之间的数据与2005年至2011年间瑞典医学出生登记表的数据进行了产后随访。 ud主要结果指标:多变量logistic回归分析用于基于英语数据开发产后静脉血栓栓塞风险预测模型,该数据在瑞典数据中得到外部验证。 ud ud结果:英语队列中确定了433-353例分娩瑞典队列中为662 387。静脉血栓栓塞的绝对发生率在英国队列中为每10 000例中7.2例,在瑞典队列中为7.9每10 000例中7.9例。在最终的多变量模型中,紧急剖腹产,死产,静脉曲张,先兆子痫/子痫,产后感染和合并症是静脉血栓栓塞的最强预测因子。在两个队列中,模型的判别相似,C统计量在0.70以上,对观察到的和预测的风险进行了很好的校准。该模型在相似的阈值下比现有的国家英语(敏感性68%对63%)和瑞典指南(30%对21%)识别出的静脉血栓栓塞事件更多。 ud ud结论:定量产后静脉绝对风险的新预测模型血栓栓塞症已得到开发并得到外部验证。它基于许多发达国家在交付时可用的临床变量,并且可以作为产科血栓预防实时决策的基础。%U http://www.bmj.com/content/bmj/355/ bmj.i6253.full.pdf

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