Development and validation of a risk model for hospital-acquired venous thrombosis: the Medical Inpatients Thrombosis and Hemostasis study

Neil A Zakai; Katherine Wilkinson; Andrew D Sparks; Ryan T Packer; Insu Koh; Nicholas S Roetker; Allen B Repp; Ryan Thomas; Chris E Holmes; Mary Cushman; Timothy B Plante; Hanny Al-Samkari; Allyson M Pishko; William A Wood; Camila Masias; Radhika Gangaraju; Ang Li; David Garcia; Kerri L Wiggins; Jordan K Schaefer; Craig Hooper; Nicholas L Smith; Leslie A McClure

doi:10.1016/j.jtha.2023.10.015

Development and validation of a risk model for hospital-acquired venous thrombosis: the Medical Inpatients Thrombosis and Hemostasis study

J Thromb Haemost. 2024 Feb;22(2):503-515. doi: 10.1016/j.jtha.2023.10.015. Epub 2023 Oct 31.

Authors

Neil A Zakai¹, Katherine Wilkinson², Andrew D Sparks³, Ryan T Packer², Insu Koh⁴, Nicholas S Roetker⁵, Allen B Repp⁶, Ryan Thomas⁶, Chris E Holmes⁶, Mary Cushman⁷, Timothy B Plante⁶, Hanny Al-Samkari⁸, Allyson M Pishko⁹, William A Wood¹⁰, Camila Masias¹¹, Radhika Gangaraju¹², Ang Li¹³, David Garcia¹⁴, Kerri L Wiggins¹⁵, Jordan K Schaefer¹⁶, Craig Hooper¹⁷, Nicholas L Smith¹⁸, Leslie A McClure¹⁹

Affiliations

¹ Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA; Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA; Department of Medicine, University of Vermont Medical Center, Burlington, Vermont, USA. Electronic address: Neil.Zakai@med.uvm.edu.
² Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA.
³ Department of Medical Biostatistics, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA.
⁴ Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA; SyllogisTeks, Chesterfield, Missouri, USA.
⁵ Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA.
⁶ Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA; Department of Medicine, University of Vermont Medical Center, Burlington, Vermont, USA.
⁷ Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA; Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA; Department of Medicine, University of Vermont Medical Center, Burlington, Vermont, USA.
⁸ Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁹ Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
¹⁰ Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
¹¹ Miami Cancer Institute, Baptist Health South Florida, Coral Gables, Florida, USA.
¹² Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA.
¹³ Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas, USA.
¹⁴ Division of Hematology, University of Washington School of Medicine, Seattle, Washington, USA.
¹⁵ Department of Medicine, University of Washington, Seattle, Washington, USA.
¹⁶ Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
¹⁷ Division of Blood Disorders, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
¹⁸ Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA; Department of Epidemiology, University of Washington, Seattle, Washington, USA; Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Office of Research and Development, Seattle, Washington, USA.
¹⁹ Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA.

PMID: 37918635
PMCID: PMC10872863 (available on 2025-02-01)
DOI: 10.1016/j.jtha.2023.10.015

Abstract

Background: Regulatory organizations recommend assessing hospital-acquired (HA) venous thromboembolism (VTE) risk for medical inpatients.

Objectives: To develop and validate a risk assessment model (RAM) for HA-VTE in medical inpatients using objective and assessable risk factors knowable at admission.

Methods: The development cohort included people admitted to medical services at the University of Vermont Medical Center (Burlington, Vermont) between 2010 and 2019, and the validation cohorts included people admitted to Hennepin County Medical Center (Minneapolis, Minnesota), University of Michigan Medical Center (Ann Arbor, Michigan), and Harris Health Systems (Houston, Texas). Individuals with VTE at admission, aged <18 years, and admitted for <1 midnight were excluded. We used a Bayesian penalized regression technique to select candidate HA-VTE risk factors for final inclusion in the RAM.

Results: The development cohort included 60 633 admissions and 227 HA-VTE, and the validation cohorts included 111 269 admissions and 651 HA-VTE. Seven HA-VTE risk factors with t statistics ≥1.5 were included in the RAM: history of VTE, low hemoglobin level, elevated creatinine level, active cancer, hyponatremia, increased red cell distribution width, and malnutrition. The areas under the receiver operating characteristic curve and calibration slope were 0.72 and 1.10, respectively. The areas under the receiver operating characteristic curve and calibration slope were 0.70 and 0.93 at Hennepin County Medical Center, 0.70 and 0.87 at the University of Michigan Medical Center, and 0.71 and 1.00 at Harris Health Systems, respectively. The RAM performed well stratified by age, sex, and race.

Conclusion: We developed and validated a RAM for HA-VTE in medical inpatients. By quantifying risk, clinicians can determine the potential benefits of measures to reduce HA-VTE.

Keywords: hospitalization; inpatients; risk assessment; risk factors; venous thrombosis.

MeSH terms

Bayes Theorem
Hospitals
Humans
Inpatients
Retrospective Studies
Risk Assessment / methods
Risk Factors
Thrombosis* / etiology
Venous Thromboembolism* / complications
Venous Thromboembolism* / diagnosis
Venous Thromboembolism* / epidemiology
Venous Thrombosis* / complications
Venous Thrombosis* / diagnosis
Venous Thrombosis* / epidemiology

Abstract

MeSH terms

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