Predictive value of the Kuijer score for bleeding and other adverse in-hospital events in patients with venous thromboembolism

Highlights

• Kuijer score is an important risk stratification tool to predict different outcomes in VTE patients.

• Kuijer score revealed a good predictive performance for major bleeding events in VTE.

• In addition, Kuijer score was also predictive for in-hospital mortality and MACCE in VTE.

Abstract

Background

Venous thromboembolism (VTE) constitute a major global burden of disease. Current international guidelines recommend treatment with anticoagulant therapy after VTE for a duration of at least 3 months. Since anticoagulation also imposes an increased risk for bleeding events, the individual risk has to be evaluated to determine adequate treatment plans.

Methods

The nationwide German inpatient sample of the years 2005–2017 was used for this analysis. Hospitalized VTE patients were stratified according to Kuijer risk class and the performance of the Kuijer score was evaluated to predict adverse in-hospital events.

Results

Overall, 1,204,895 VTE patients were treated between 2005 and 2017 in Germany and were included in the present study (839,143 patients had deep venous thrombosis and/or thrombophlebitis and 669,881 patients pulmonary embolism). According to Kuijer risk class stratification, in total, 176,723 (14.7%) of the hospitalized VTE patients were classified as low risk, 914,964 (75.9%) as intermediate risk and 113,208 (9.4%) as high risk.

A higher Kuijer risk class was predictive for in-hospital death (odds ratio [OR] 1.99 [95% confidence interval (CI) 1.96–2.02], P < 0.001), major adverse cardiovascular and cerebrovascular events (MACCE, OR 1.90 [95%CI 1.87–1.93], P < 0.001), intracerebral bleeding (OR 1.28 [95%CI 1.14–1.44], P < 0.001), gastrointestinal bleeding (OR 1.56 [95%CI 1.48–1.64], P < 0.001) as well as necessity of transfusion of blood constituents (OR 2.94 [95%CI 2.88–3.00], P < 0.001) independently of important comorbidities.

Conclusions

The Kuijer score is an important risk stratification tool to predict individual risk regarding in-hospital outcomes comprising major bleeding events such as intracerebral bleeding and necessity of transfusion of blood constituents, but also in-hospital mortality and MACCE in VTE patients.

Introduction

Venous thromboembolism (VTE), including both deep vein thrombosis and pulmonary embolism (PE) affects approximately 1–2 adults per 1000 individuals every year [1]. Thus, VTE is a commonly diagnosed condition with significant morbidity and mortality [2]. Current international guidelines recommend treatment with anticoagulant therapy for acute PE and/or deep vein thrombosis for a duration of at least 3 months [3,4]. The aim of anticoagulation therapy is to treat the current VTE and to prevent recurrent VTE events [1,[3], [4], [5], [6]]. However, anticoagulation also imposes an increased risk for minor and major bleeding events and this risk of every VTE patient must be evaluated to determine adequate treatment plans for each VTE patient [1,4]. Bleeding events are the main adverse outcome seen with the anticoagulant therapy and major bleeding events are potentially life-threatening complications of this therapy [7,8]. However, it remains challenging to quantify the individual risk of major bleeding [9,10]. Although several risk assessment models and scores have been developed in the past years (Table 1) [[10], [11], [12], [13], [14], [15], [16], [17], [18]], their usage is not common in daily clinical routine due to complex and mostly time-consuming assessment. An exception among these risk assessment models and scores regarding time-consuming assessment represents the Kuijer score, which could easily be assessed [14].

Thus, the objective of our study was to investigate the usage of the Kuijer score to predict major bleeding events such as intracerebral bleeding as well as death, major adverse cardiac and cerebrovascular events and other adverse events during in-hospital stay.