Prediction of primary venous thromboembolism based on clinical and genetic factors within the U.K. Biobank

David A Kolin,Scott Kulm,Olivier Elemento

doi:10.1038/s41598-021-00796-4

Abstract

Both clinical and genetic factors drive the risk of venous thromboembolism. However, whether clinically recorded risk factors and genetic variants can be combined into a clinically applicable predictive score remains unknown. Using Cox proportional-hazard models, we analyzed the association of risk factors with the likelihood of venous thromboembolism in U.K. Biobank, a large prospective cohort. We then created a polygenic risk score of 36 single nucleotide polymorphisms and a clinical score determined by age, sex, body mass index, previous cancer diagnosis, smoking status, and fracture in the last 5 years. Participants were at significantly increased risk of venous thromboembolism if they were at high clinical risk (subhazard ratio, 4.37 [95% CI, 3.85–4.97]) or high genetic risk (subhazard ratio, 3.02 [95% CI, 2.63–3.47]) relative to participants at low clinical or genetic risk, respectively. The combined model, consisting of clinical and genetic components, was significantly better than either the clinical or the genetic model alone (P < 0.001). Participants at high risk in the combined score had nearly an eightfold increased risk of venous thromboembolism relative to participants at low risk (subhazard ratio, 7.51 [95% CI, 6.28–8.98]). This risk score can be used to guide decisions regarding venous thromboembolism prophylaxis, although external validation is needed.

Highlights

Both clinical and genetic factors drive the likelihood of venous thromboembolism, the leading cause of preventable hospital d eaths[1]
In the first section of the statistical analysis, we investigated the association of clinical risk factors with venous thromboembolism using a causal modeling approach on the full dataset
In exploratory analyses of the length of use of contraception, we found that women who used contraception for at least 20 years were at decreased risk of venous thromboembolism (HR, 0.80 [95% CI, 0.65–0.98])

Summary

Introduction

Both clinical and genetic factors drive the likelihood of venous thromboembolism, the leading cause of preventable hospital d eaths[1]. While clinical factors account for a significant proportion of thromboembolic risk, over 60% of variation in the risk of venous thromboembolism can be attributed to genetic factors[8]. Risk alleles, when combined into a polygenic score, are capable of quantifying genetic susceptibility and are often more effective at predicting risk than rare monogenic variants a lone[15,16,17,18,19,20,21,22]. A continuous score for prognosticating venous thromboembolism—by combining clinical and genetic factors—is not routinely used for the general population. We transitioned from causal modeling to predictive modeling, developing and validating a multivariable venous thromboembolism risk model, comprised of clinical and genetic predictors

Methods

Results

Conclusion