The prognostic value of ORBIT risk score in predicting major bleeding in patients with acute coronary syndrome
The most significant adverse effect of antithrombotic medication in acute coronary syndrome (ACS) is major bleeding, which is related to increased mortality. Studies on ORBIT risk score in predicting major bleeding in ACS patients are limited. This research aimed to examine whether the ORBIT score c...
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| Veröffentlicht in: | Thrombosis research 2023-09, Vol.229, p.258-262 |
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| creator | Günlü, Serhat Arpa, Abdulkadir Kayan, Fethullah Güzel, Tuncay Kılıç, Raif Aktan, Adem Altintaş, Bernas Karahan, Mehmet Zülkif |
| description | The most significant adverse effect of antithrombotic medication in acute coronary syndrome (ACS) is major bleeding, which is related to increased mortality. Studies on ORBIT risk score in predicting major bleeding in ACS patients are limited.
This research aimed to examine whether the ORBIT score calculated at the bedside can identify major bleeding risk in patients with ACS.
This research was retrospective, observational, and conducted at a single center. Analyses of receiver operating characteristics (ROC) were utilized to define the diagnostic value of CRUSADE and ORBIT scores. The predictive performances of the two scores were compared using DeLong's method. Discrimination and reclassification performances were evaluated by the integrated discrimination improvement (IDI), and net reclassification improvement (NRI).
The study included 771 patients with ACS. The mean age was 68.7 ± 8.6 years, with 35.3 % females. 31 patients had major bleeding. Twenty-three of these patients were BARC 3 A, five were BARC 3 B, and three were BARC 3 C. Bleeding history [OR (95 % CI), 2.46 (1.02–5.94), p = 0.021], hemoglobin levels [OR (95 % CI), 0.54 (0.45–0.63), p 74 years [OR (95 % CI), 1.03 (1.01–1.06), p = 0.039] were independent predictors of major bleeding. The ORBIT score was an independent predictor of major bleeding in the multivariate analysis: continuous variables [OR (95 % CI), 2.53 (2.61–3.95), p |
| doi_str_mv | 10.1016/j.thromres.2023.05.007 |
| format | Article |
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This research aimed to examine whether the ORBIT score calculated at the bedside can identify major bleeding risk in patients with ACS.
This research was retrospective, observational, and conducted at a single center. Analyses of receiver operating characteristics (ROC) were utilized to define the diagnostic value of CRUSADE and ORBIT scores. The predictive performances of the two scores were compared using DeLong's method. Discrimination and reclassification performances were evaluated by the integrated discrimination improvement (IDI), and net reclassification improvement (NRI).
The study included 771 patients with ACS. The mean age was 68.7 ± 8.6 years, with 35.3 % females. 31 patients had major bleeding. Twenty-three of these patients were BARC 3 A, five were BARC 3 B, and three were BARC 3 C. Bleeding history [OR (95 % CI), 2.46 (1.02–5.94), p = 0.021], hemoglobin levels [OR (95 % CI), 0.54 (0.45–0.63), p < 0.001], and age > 74 years [OR (95 % CI), 1.03 (1.01–1.06), p = 0.039] were independent predictors of major bleeding. The ORBIT score was an independent predictor of major bleeding in the multivariate analysis: continuous variables [OR (95 % CI), 2.53 (2.61–3.95), p < 0.001] and risk categories [OR (95 % CI), 3.06 (1.69–5.52), p < 0.001]. Comparison of c-indexes for major bleeding events revealed a non-significant difference for the discriminative ability of the two tested scores (p = 0.07) with a continuous NRI of 6.6 % (p = 0.026) and an IDI of 4.2 % (p < 0.001).
In ACS patients, the ORBIT score independently predicted major bleeding.
•The ORBIT bleeding risk score is straightforward bedside methods for assessing patients with ACS.•ORBIT was the sole independent predictor of major bleeding, demonstrating a higher ability for distinguishing than CRUSADE.•The ORBIT score has 89 % specificity and 78 % sensitivity.</description><identifier>ISSN: 0049-3848</identifier><identifier>EISSN: 1879-2472</identifier><identifier>DOI: 10.1016/j.thromres.2023.05.007</identifier><identifier>PMID: 37236868</identifier><language>eng</language><publisher>United States: Elsevier Ltd</publisher><subject>Acute coronary syndrome ; Anticoagulant therapy ; Antithrombotic therapy ; Major bleeding ; Risk assessment</subject><ispartof>Thrombosis research, 2023-09, Vol.229, p.258-262</ispartof><rights>2023 Elsevier Ltd</rights><rights>Copyright © 2023 Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c368t-68038859c84c893cdbb8eb382110c374f6943ae05a871f7572613ac14775f1c53</citedby><cites>FETCH-LOGICAL-c368t-68038859c84c893cdbb8eb382110c374f6943ae05a871f7572613ac14775f1c53</cites><orcidid>0000-0002-8875-5672 ; 0000-0002-8338-4948 ; 0000-0001-8470-1928 ; 0000-0002-6077-0416 ; 0000-0003-0505-9784 ; 0000-0003-1662-3061 ; 0000-0001-8145-9574 ; 0000-0001-6985-6112</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.thromres.2023.05.007$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,782,786,3554,27933,27934,46004</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37236868$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Günlü, Serhat</creatorcontrib><creatorcontrib>Arpa, Abdulkadir</creatorcontrib><creatorcontrib>Kayan, Fethullah</creatorcontrib><creatorcontrib>Güzel, Tuncay</creatorcontrib><creatorcontrib>Kılıç, Raif</creatorcontrib><creatorcontrib>Aktan, Adem</creatorcontrib><creatorcontrib>Altintaş, Bernas</creatorcontrib><creatorcontrib>Karahan, Mehmet Zülkif</creatorcontrib><title>The prognostic value of ORBIT risk score in predicting major bleeding in patients with acute coronary syndrome</title><title>Thrombosis research</title><addtitle>Thromb Res</addtitle><description>The most significant adverse effect of antithrombotic medication in acute coronary syndrome (ACS) is major bleeding, which is related to increased mortality. Studies on ORBIT risk score in predicting major bleeding in ACS patients are limited.
This research aimed to examine whether the ORBIT score calculated at the bedside can identify major bleeding risk in patients with ACS.
This research was retrospective, observational, and conducted at a single center. Analyses of receiver operating characteristics (ROC) were utilized to define the diagnostic value of CRUSADE and ORBIT scores. The predictive performances of the two scores were compared using DeLong's method. Discrimination and reclassification performances were evaluated by the integrated discrimination improvement (IDI), and net reclassification improvement (NRI).
The study included 771 patients with ACS. The mean age was 68.7 ± 8.6 years, with 35.3 % females. 31 patients had major bleeding. Twenty-three of these patients were BARC 3 A, five were BARC 3 B, and three were BARC 3 C. Bleeding history [OR (95 % CI), 2.46 (1.02–5.94), p = 0.021], hemoglobin levels [OR (95 % CI), 0.54 (0.45–0.63), p < 0.001], and age > 74 years [OR (95 % CI), 1.03 (1.01–1.06), p = 0.039] were independent predictors of major bleeding. The ORBIT score was an independent predictor of major bleeding in the multivariate analysis: continuous variables [OR (95 % CI), 2.53 (2.61–3.95), p < 0.001] and risk categories [OR (95 % CI), 3.06 (1.69–5.52), p < 0.001]. Comparison of c-indexes for major bleeding events revealed a non-significant difference for the discriminative ability of the two tested scores (p = 0.07) with a continuous NRI of 6.6 % (p = 0.026) and an IDI of 4.2 % (p < 0.001).
In ACS patients, the ORBIT score independently predicted major bleeding.
•The ORBIT bleeding risk score is straightforward bedside methods for assessing patients with ACS.•ORBIT was the sole independent predictor of major bleeding, demonstrating a higher ability for distinguishing than CRUSADE.•The ORBIT score has 89 % specificity and 78 % sensitivity.</description><subject>Acute coronary syndrome</subject><subject>Anticoagulant therapy</subject><subject>Antithrombotic therapy</subject><subject>Major bleeding</subject><subject>Risk assessment</subject><issn>0049-3848</issn><issn>1879-2472</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNqFkE9P3DAQxS1UVBbar4B85JIwtpPYuZWi8kdCQkLbs-U4E9ZLElPb2Ypvj1cLvfZkjee9mTc_Qs4ZlAxYc7kt0yb4KWAsOXBRQl0CyCOyYkq2Ba8k_0JWAFVbCFWpE3Ia4xaASdbWX8mJkFw0qlErMq83SF-Df559TM7SnRkXpH6gj08_79c0uPhCo_UBqZuzDntnk5uf6WS2PtBuxPyTy33TJIdzivSvSxtq7JKQZqOfTXij8W3uc1z8Ro4HM0b8_vGekd83v9bXd8XD4-399dVDYXOuVDQKhFJ1a1VlVSts33UKO6E4Y2CFrIamrYRBqI2SbJC15A0TxrJKynpgthZn5OIwN5_2Z8GY9OSixXE0M_olaq44AG-kYFnaHKQ2-BgDDvo1uCmH1gz0nrXe6k_Wes9aQ60z62w8_9ixdBP2_2yfcLPgx0GA-dKdw6CjzYhsRhbQJt17978d75bhlDc</recordid><startdate>20230901</startdate><enddate>20230901</enddate><creator>Günlü, Serhat</creator><creator>Arpa, Abdulkadir</creator><creator>Kayan, Fethullah</creator><creator>Güzel, Tuncay</creator><creator>Kılıç, Raif</creator><creator>Aktan, Adem</creator><creator>Altintaş, Bernas</creator><creator>Karahan, Mehmet Zülkif</creator><general>Elsevier Ltd</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8875-5672</orcidid><orcidid>https://orcid.org/0000-0002-8338-4948</orcidid><orcidid>https://orcid.org/0000-0001-8470-1928</orcidid><orcidid>https://orcid.org/0000-0002-6077-0416</orcidid><orcidid>https://orcid.org/0000-0003-0505-9784</orcidid><orcidid>https://orcid.org/0000-0003-1662-3061</orcidid><orcidid>https://orcid.org/0000-0001-8145-9574</orcidid><orcidid>https://orcid.org/0000-0001-6985-6112</orcidid></search><sort><creationdate>20230901</creationdate><title>The prognostic value of ORBIT risk score in predicting major bleeding in patients with acute coronary syndrome</title><author>Günlü, Serhat ; Arpa, Abdulkadir ; Kayan, Fethullah ; Güzel, Tuncay ; Kılıç, Raif ; Aktan, Adem ; Altintaş, Bernas ; Karahan, Mehmet Zülkif</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c368t-68038859c84c893cdbb8eb382110c374f6943ae05a871f7572613ac14775f1c53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Acute coronary syndrome</topic><topic>Anticoagulant therapy</topic><topic>Antithrombotic therapy</topic><topic>Major bleeding</topic><topic>Risk assessment</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Günlü, Serhat</creatorcontrib><creatorcontrib>Arpa, Abdulkadir</creatorcontrib><creatorcontrib>Kayan, Fethullah</creatorcontrib><creatorcontrib>Güzel, Tuncay</creatorcontrib><creatorcontrib>Kılıç, Raif</creatorcontrib><creatorcontrib>Aktan, Adem</creatorcontrib><creatorcontrib>Altintaş, Bernas</creatorcontrib><creatorcontrib>Karahan, Mehmet Zülkif</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Thrombosis research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Günlü, Serhat</au><au>Arpa, Abdulkadir</au><au>Kayan, Fethullah</au><au>Güzel, Tuncay</au><au>Kılıç, Raif</au><au>Aktan, Adem</au><au>Altintaş, Bernas</au><au>Karahan, Mehmet Zülkif</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The prognostic value of ORBIT risk score in predicting major bleeding in patients with acute coronary syndrome</atitle><jtitle>Thrombosis research</jtitle><addtitle>Thromb Res</addtitle><date>2023-09-01</date><risdate>2023</risdate><volume>229</volume><spage>258</spage><epage>262</epage><pages>258-262</pages><issn>0049-3848</issn><eissn>1879-2472</eissn><abstract>The most significant adverse effect of antithrombotic medication in acute coronary syndrome (ACS) is major bleeding, which is related to increased mortality. Studies on ORBIT risk score in predicting major bleeding in ACS patients are limited.
This research aimed to examine whether the ORBIT score calculated at the bedside can identify major bleeding risk in patients with ACS.
This research was retrospective, observational, and conducted at a single center. Analyses of receiver operating characteristics (ROC) were utilized to define the diagnostic value of CRUSADE and ORBIT scores. The predictive performances of the two scores were compared using DeLong's method. Discrimination and reclassification performances were evaluated by the integrated discrimination improvement (IDI), and net reclassification improvement (NRI).
The study included 771 patients with ACS. The mean age was 68.7 ± 8.6 years, with 35.3 % females. 31 patients had major bleeding. Twenty-three of these patients were BARC 3 A, five were BARC 3 B, and three were BARC 3 C. Bleeding history [OR (95 % CI), 2.46 (1.02–5.94), p = 0.021], hemoglobin levels [OR (95 % CI), 0.54 (0.45–0.63), p < 0.001], and age > 74 years [OR (95 % CI), 1.03 (1.01–1.06), p = 0.039] were independent predictors of major bleeding. The ORBIT score was an independent predictor of major bleeding in the multivariate analysis: continuous variables [OR (95 % CI), 2.53 (2.61–3.95), p < 0.001] and risk categories [OR (95 % CI), 3.06 (1.69–5.52), p < 0.001]. Comparison of c-indexes for major bleeding events revealed a non-significant difference for the discriminative ability of the two tested scores (p = 0.07) with a continuous NRI of 6.6 % (p = 0.026) and an IDI of 4.2 % (p < 0.001).
In ACS patients, the ORBIT score independently predicted major bleeding.
•The ORBIT bleeding risk score is straightforward bedside methods for assessing patients with ACS.•ORBIT was the sole independent predictor of major bleeding, demonstrating a higher ability for distinguishing than CRUSADE.•The ORBIT score has 89 % specificity and 78 % sensitivity.</abstract><cop>United States</cop><pub>Elsevier Ltd</pub><pmid>37236868</pmid><doi>10.1016/j.thromres.2023.05.007</doi><tpages>5</tpages><orcidid>https://orcid.org/0000-0002-8875-5672</orcidid><orcidid>https://orcid.org/0000-0002-8338-4948</orcidid><orcidid>https://orcid.org/0000-0001-8470-1928</orcidid><orcidid>https://orcid.org/0000-0002-6077-0416</orcidid><orcidid>https://orcid.org/0000-0003-0505-9784</orcidid><orcidid>https://orcid.org/0000-0003-1662-3061</orcidid><orcidid>https://orcid.org/0000-0001-8145-9574</orcidid><orcidid>https://orcid.org/0000-0001-6985-6112</orcidid></addata></record> |
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| subjects | Acute coronary syndrome Anticoagulant therapy Antithrombotic therapy Major bleeding Risk assessment |
| title | The prognostic value of ORBIT risk score in predicting major bleeding in patients with acute coronary syndrome |
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