Predictors of 30-day mortality in patients with an international normalized ratio of 4.5 - 10 due to warfarin-related overanticoagulation: a retrospective cohort study

Mehmet Muzaffer İslam

Makale detayları

Predictors of 30-day mortality in patients with an international normalized ratio of 4.5 - 10 due to warfarin-related overanticoagulation: a retrospective cohort study

Yazarlar:

Mehmet Muzaffer İslam

Yayıncı:

Cukurova University

Ana Başlıklar:

Klinik Tıp Bilimleri

Dergi:

Cukurova Medical Journal Vol.48 Issue 2, pp.654-662

Belge Tipi:

Makale

Yayın Tarihi:

2/2023

Belge Dili:

İngilizce

Document ID (Org No.):

2001286365

pISSN:

2602-3032

Anahtar kelimeler:

Özet:

 Purpose: Although it has been shown that vitamin K administration does not benefit patients with INR levels between 4.5 to 10, there are studies in the literature showing that some complications including the risk of bleeding in these patients increase significantly. For this reason, it is crucial to select high-risk patients who present with elevated INR to apply closer follow-up and monitoring. The primary objective of our study is to define the predictors for 30-day mortality of the patients with an INR between 4.5 to 10 due to warfarin-related overanticoagulation. The secondary objective of our study is to derive a regression model which can predict mortality in 30 days and to compare the performance of this model with the National Early Warning Score-2NEWS-2. Materials and Methods: We included patients older than 18 years old, admitted between the dates 01.01.2016 - 01.01.2022 who are using warfarin as medication and with an INR between 4.5  10 in our study. We excluded patients with trauma, major bleeding on admission or patients with missing data. For the regression model, backward-wald stepwise method was utilized. We used the Hosmer-Lemeshow test for the goodness of fit. For the overall performance of the model, we evaluated the Nagelkerke R Square, and the Reciever Operating Characteristics test. DeLong test was used to compare the area under the curves AUC. Results: A total of 263 patients were examined in the statistical analysis. Mean arterial pressure, SpO2, pulse rate, and age were the independent predictors of 30-day mortality. The model have classified 81.4 of the patients correctly. The AUC of the regression model was 0.848 0.799 to 0.898. The sensitivity of the model as a tool for mortality prediction was 94.1, specificity 66.5, and accuracy 71.9. The AUC of the NEWS-2 score for 30-day mortality was calculated as 0.782 95CI  0.715 to 0.849. The difference between the AUCs of our model and the NEWS-2 score was statistically significant. Conclusion: Mean arterial pressure, SpO2, heart rate, and age were the independent predictors for the 30-day mortality of patients with an INR between 4.5 to 10 due to overanticoagulation because of warfarin medication. The regression model we derived showed good overall discrimination and performed significantly better than NEWS-2 score.

 Purpose: Although it has been shown that vitamin K administration does not benefit patients with INR levels between 4.5 to 10, there are studies in the literature showing that some complications including the risk of bleeding in these patients increase significantly. For this reason, it is crucial to select high-risk patients who present with elevated INR to apply closer follow-up and monitoring. The primary objective of our study is to define the predictors for 30-day mortality of the patients with an INR between 4.5 to 10 due to warfarin-related overanticoagulation. The secondary objective of our study is to derive a regression model which can predict mortality in 30 days and to compare the performance of this model with the National Early Warning Score-2NEWS-2. Materials and Methods: We included patients older than 18 years old, admitted between the dates 01.01.2016 - 01.01.2022 who are using warfarin as medication and with an INR between 4.5  10 in our study. We excluded patients with trauma, major bleeding on admission or patients with missing data. For the regression model, backward-wald stepwise method was utilized. We used the Hosmer-Lemeshow test for the goodness of fit. For the overall performance of the model, we evaluated the Nagelkerke R Square, and the Reciever Operating Characteristics test. DeLong test was used to compare the area under the curves AUC. Results: A total of 263 patients were examined in the statistical analysis. Mean arterial pressure, SpO2, pulse rate, and age were the independent predictors of 30-day mortality. The model have classified 81.4 of the patients correctly. The AUC of the regression model was 0.848 0.799 to 0.898. The sensitivity of the model as a tool for mortality prediction was 94.1, specificity 66.5, and accuracy 71.9. The AUC of the NEWS-2 score for 30-day mortality was calculated as 0.782 95CI  0.715 to 0.849. The difference between the AUCs of our model and the NEWS-2 score was statistically significant. Conclusion: Mean arterial pressure, SpO2, heart rate, and age were the independent predictors for the 30-day mortality of patients with an INR between 4.5 to 10 due to overanticoagulation because of warfarin medication. The regression model we derived showed good overall discrimination and performed significantly better than NEWS-2 score.

 Purpose: Although it has been shown that vitamin K administration does not benefit patients with INR levels between 4.5 to 10, there are studies in the literature showing that some complications including the risk of bleeding in these patients increase significantly. For this reason, it is crucial to select high-risk patients who present with elevated INR to apply closer follow-up and monitoring. The primary objective of our study is to define the predictors for 30-day mortality of the patients with an INR between 4.5 to 10 due to warfarin-related overanticoagulation. The secondary objective of our study is to derive a regression model which can predict mortality in 30 days and to compare the performance of this model with the National Early Warning Score-2NEWS-2. Materials and Methods: We included patients older than 18 years old, admitted between the dates 01.01.2016 - 01.01.2022 who are using warfarin as medication and with an INR between 4.5  10 in our study. We excluded patients with trauma, major bleeding on admission or patients with missing data. For the regression model, backward-wald stepwise method was utilized. We used the Hosmer-Lemeshow test for the goodness of fit. For the overall performance of the model, we evaluated the Nagelkerke R Square, and the Reciever Operating Characteristics test. DeLong test was used to compare the area under the curves AUC. Results: A total of 263 patients were examined in the statistical analysis. Mean arterial pressure, SpO2, pulse rate, and age were the independent predictors of 30-day mortality. The model have classified 81.4 of the patients correctly. The AUC of the regression model was 0.848 0.799 to 0.898. The sensitivity of the model as a tool for mortality prediction was 94.1, specificity 66.5, and accuracy 71.9. The AUC of the NEWS-2 score for 30-day mortality was calculated as 0.782 95CI  0.715 to 0.849. The difference between the AUCs of our model and the NEWS-2 score was statistically significant. Conclusion: Mean arterial pressure, SpO2, heart rate, and age were the independent predictors for the 30-day mortality of patients with an INR between 4.5 to 10 due to overanticoagulation because of warfarin medication. The regression model we derived showed good overall discrimination and performed significantly better than NEWS-2 score.

 Amaç: K vitamini uygulamasının international normalized ratioINR değeri 4.5 ila 10 arasında olan hastalara fayda sağlamadığı gösterilmiş olmasına rağmen, literatür bu hasta grubunda kanama dahil olmak üzere bazı komplikasyonların önemli ölçüde arttığını göstermektedir. Bu nedenle, INR düzeyi artmış hastalarda yüksek risk taşıyan hastaların belirlenmesi ve daha yakın takip ve izlem altına alınması önemlidir. Çalışmamızın birincil amacı, varfarin ilişkili aşırı antikoagülasyon nedeniyle INR değeri 4.5 - 10 arasında olan hastaların 30 günlük mortalite prediktörlerini belirlemektir. Çalışmamızın ikincil amacı, 30 gün içindeki mortaliteyi öngören bir regresyon modeli oluşturmak ve bu modelin performansını National Early Warning Score-2 NEWS-2 ile karşılaştırmaktır. Gereç ve Yöntem: Çalışmamıza, 01.01.2016 - 01.01.2022 tarihleri arasında hastaneye başvuran, 18 yaşından büyük, warfarin kullanan ve INR değeri 4.5 ila 10 arasında olan hastalar dahil edildi. Travma ile başvuran, başvuru esnasında majör kanaması olan veya veri eksiği olan hastalar çalışmamızdan dışlandı. Regresyon modeli için, backward-Wald stepwise yöntemi kullanıldı. Modelin fitliği Hosmer-Lemeshow ile test edildi. Modelin genel performansı Nagelkerke R Square ile değerlendirildi ve Reciever Operating Characteristics testi uygulandı. Eğri altında kalan alanların AUC karşılaştırması için DeLong testi kullanıldı. Bulgular: İstatistiksel analizde toplam 263 hasta dahil edildi. Ortalama arteriyel basınç, SpO2, nabız ve yaş, 30 günlük mortalitenin bağımsız prediktörleri olarak bulundu. Model, hastaların 81.4ünü doğru şekilde sınıflandırdı. Regresyon modelinin AUC değeri 0.848 0.799 - 0.898 olarak hesaplandı. Mortalite tahminindeki tanısal performansı incelendiğinde duyarlılığı 94.1, özgüllüğü 66.5 ve doğruluğu 71.9 olarak hesaplandı. 30 günlük mortalite için NEWS-2 skorunun AUC değeri 0.78295 CI  0.715 - 0.849 olarak hesaplandı. Modelimizin ve NEWS-2 skoru arasındaki AUC farkı istatistiksel olarak anlamlı bulundu. Sonuç: Ortalama arteriyel basınç, SpO2, nabız ve yaş, varfarin kullanımına bağlı olarak INR değeri 4.5-10 arasında olan hastalarda 30 günlük mortalite için bağımsız prediktörler olduğu saptandı. Elde ettiğimiz regresyon modeli genel olarak iyi bir sınıflama sağladı ve NEWS-2 skorundan anlamlı şekilde daha iyi performans gösterdi.

Makale detayları

Predictors of 30-day mortality in patients with an international normalized ratio of 4.5 - 10 due to warfarin-related overanticoagulation: a retrospective cohort study

Yazarlar:

Mehmet Muzaffer İslam

Yayıncı:

Cukurova University

Ana Başlıklar:

Klinik Tıp Bilimleri

Dergi:

Cukurova Medical Journal Vol.48 Issue 2, pp.654-662

Belge Tipi:

Makale

Yayın Tarihi:

2/2023

Belge Dili:

İngilizce

Document ID (Org No.):

2001286365

pISSN:

2602-3032

Warfarin

Supratherapeutic INR

Overanticoagulation

Vitamin-K

Predictors of mortality

Varfarin

yüksek INR

aşırı antikoagülasyon

K vitamini

mortalite prediktörleri

Sayı

Makale detayları

Yazarlar: Mehmet Muzaffer İslam

Yayıncı: Cukurova University

Ana Başlıklar: Klinik Tıp Bilimleri

Dergi: Cukurova Medical Journal Vol.48 Issue 2, pp.654-662

Belge Tipi: Makale

Yayın Tarihi: 2/2023

Belge Dili: İngilizce

Document ID (Org No.): 2001286365

pISSN: 2602-3032

Sayı

Yazarlar:

Mehmet Muzaffer İslam

Yayıncı:

Cukurova University

Ana Başlıklar:

Klinik Tıp Bilimleri

Dergi:

Cukurova Medical Journal Vol.48 Issue 2, pp.654-662

Belge Tipi:

Makale

Yayın Tarihi:

2/2023

Belge Dili:

İngilizce

Document ID (Org No.):

2001286365

pISSN:

2602-3032