ORBIT评分与HAS-BLED评分对心脏瓣膜置换术后华法林抗凝出血风险的预测价值比较

赵慧明; 刘勇; 粟丽; 夏浩然; 陈婷; 王亚莉

doi:10.7619/jcmp.20233034

ORBIT评分与HAS-BLED评分对心脏瓣膜置换术后华法林抗凝出血风险的预测价值比较

Comparative study in predictive value of ORBIT score and HAS-BLED score for warfarin anticoagulation bleeding risk after heart valve replacement

摘要

摘要:
目的比较ORBIT评分与HAS-BLED评分对心脏瓣膜置换术后华法林抗凝出血风险的预测价值。
方法回顾性分析304例心脏瓣膜置换术后需行华法林抗凝治疗患者的病例资料，分别根据ORBIT评分和HAS-BLED评分对患者进行风险分层和分组，分析基于不同评分的风险分层与术后华法林抗凝出血事件的相关性，比较2种评分方法风险分层的一致性及其对出血事件的预测价值。
结果 304例患者中，出血患者32例、未出血患者272例，出血患者的术后ORBIT评分、HAS-BLED评分均高于未出血患者，差异有统计学意义(P < 0.05)。基于ORBIT评分划分的中危、高危患者的出血风险分别为低危患者的6.092(95%CI: 2.694~13.775)倍、9.373(95%CI: 1.465~59.943)倍，基于HAS-BLED评分划分的中危、高危患者的出血风险分别为低危患者的3.750(95%CI: 1.383~10.166)倍、14.250(95%CI: 5.489~36.995)倍。受试者工作特征曲线分析结果显示, ORBIT评分预测华法林抗凝出血风险的曲线下面积(AUC)为0.646(95%CI: 0.589~0.699), 敏感度为46.88%, 特异度为87.87%, 最佳截断值为3分; HAS-BLED评分预测华法林抗凝出血风险的AUC为0.768(95%CI: 0.717~0.814), 敏感度为75.00%, 特异度为69.85%, 最佳截断值为2分; Delong检验结果显示, 2种评分的AUC差异有统计学意义(D=0.122, 95%CI: 0.001~0.245, Z=1.962, P < 0.05)。
结论 ORBIT评分和HAS-BLED评分对心脏瓣膜置换术后华法林抗凝出血风险均具有一定预测价值，其中HAS-BLED评分的预测效能更优。

Abstract:
Objective To compare the predictive value of ORBIT score and HAS-BLED score for bleeding risk after warfarin anticoagulation following heart valve replacement.
Methods The clinical data of 304 patients who underwent heart valve replacement and required warfarin anticoagulation therapy were retrospectively analyzed. The patients were stratified and grouped based on the ORBIT score and HAS-BLED score. The correlation between risk stratification based on different scores and postoperative bleeding events during warfarin anticoagulation was analyzed. The consistency of risk stratification between the two scoring methods and their predictive value for bleeding events were compared.
Results Among 304 patients, there were 32 bleeding patients and 272 non-bleeding patients. The postoperative ORBIT and HAS-BLED scores of the bleeding patients were higher than those of non-bleeding patients(P < 0.05). The bleeding risk of medium and high-risk patients based on the ORBIT score was 6.092 (95%CI, 2.694 to 13.775) times and 9.373 (95%CI, 1.465 to 59.943) times higher than that of low-risk patients, respectively. The bleeding risk of medium and high-risk patients based on the HAS-BLED score was 3.750 (95%CI, 1.383 to 10.166) times and 14.250 (95%CI, 5.489 to 36.995) times higher than that of low-risk patients, respectively. The analysis of the receiver operating characteristic curve showed that the area under the AUC (95%CI, 0.589 0.698 9) of ORBIT score for predicting the risk of postoperative warfarin anticoagulation bleeding was 0.646 (95%CI, 0.589 to 0.699), with a sensitivity of 46.88% and a specificity of 87.87%, and an optimal cutoff value of 3 points. The AUC of HAS-BLED score predicting the risk of postoperative anticoagulation bleeding with warfarin was 0.768 (95%CI, 0.717 to 0.814), with a sensitivity of 75.00% and a specificity of 69.85%, and an optimal cutoff value of 2 points. The Delong test results showed that there was a statistically significant difference in AUC between the two scores (D=0.122; 95%CI, 0.001 to 0.245; Z=1.962; P < 0.05).
Conclusion Both ORBIT score and HAS-BLED score have certain predictive value for bleeding risk during warfarin anticoagulation after heart valve replacement, but the predictive efficiency of HAS-BLED score is better.

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