A Novel Risk Score to Predict Deep Vein Thrombosis After Spontaneous Intracerebral Hemorrhage

Abstract

Background: Studies showed that patients with hemorrhagic stroke are at higher risk of developing deep vein thrombosis (DVT) than those with ischemic stroke. We aimed to develop a risk score (intracerebral hemorrhage associated deep vein thrombosis score, ICH-DVT) for predicting in-hospital DVT after ICH. Methods: The ICH-DVT was developed based on the Beijing Registration of Intracerebral Hemorrhage, in which eligible patients were randomly divided into derivation (60%) and internal validation cohort (40%). External validation was performed using the iMCAS study (In-hospital Medical Complication after Acute Stroke). Independent predictors of in-hospital DVT after ICH were obtained using multivariable logistic regression and β-coefficients were used to generate scoring system of the ICH-DVT. The area under the receiver operating characteristic curve (AUROC) and the Hosmer-Lemeshow goodness-of-fit test was used to assess model discrimination and calibration. Findings: The overall in-hospital DVT after ICH was 6.3%,6.0%, and 5.7% in the derivation (n=1309), internal (n=655) and external (n=314) validation cohorts, respectively. A 31-point ICH-DVT was developed from the set of independent predictors including age, hematoma volume, subarachnoid extension, pneumonia, gastrointestinal bleeding and length of hospitalization. The ICH-DVT showed good discrimination (AUROC) in the derivation (0.81; 95%CI=0.79-0.83), internal (0.83, 95%CI=0.80-0.86) and external (0.88; 95%CI=0.84-0.92) validation cohorts. The ICH-DVT was well calibrated (Hosmer-Lemeshow test) in the derivation (P=0.53), internal (P=0.38) and external (P=0.06) validation cohorts. Interpretation: The ICH-DVT is a valid grading scale for predicting in-hospital DVT after ICH. Further studies on effect of the ICH-DVT on clinical outcomes after ICH are warranted. Funding Information: This study was sponsored by Capital health research and development of special (2011-2004-03) and Beijing Municipal Science & Technology Commission (Z131107002213009). This study was partially supported by the Nova Program of Beijing Science and Technology Commission (2008B30), National Natural Science Foundation of China (81471208, 81641162), Beijing highlevel healthy human resource project (014-3-033) and Shandong Province Key Innovation Project (2019JZZY020901). Declaration of Interests: All authors report no disclosures. Ethics Approval Statement: The study protocol was approved by the Institutional Review Board (IRB) of the Beijing Tiantan Hospital (KY2014-023-02). The iMCAS was approved by the ethics committee of Beijing Tiantan hospital. For the present study, only patients with ICH were included.