Validation of the 5-SNP score for the prediction of venous thromboembolism in a Danish fast-track cohort of 6,789 total hip and total knee arthroplasty patients

Abstract

Listen

Translate article

BackgroundVenous thromboembolism (VTE) is a serious complication following total hip arthroplasty (THA) and total knee arthroplasty (TKA). Despite improvements with fast-track treatment protocols, still 0.5% of patients develop a VTE within 90-days postoperatively. Previously, the 5-SNP genetic risk scores (weighted and simplified), were developed to identify people at a high risk of VTE within the general population. ObjectivesWe aimed to assess whether the 5-SNP scores could be used to identify high-risk patients in a cohort of fast-track THA/TKA patients. Patients/MethodsA subset of patients from the Lundbeck Centre for Fast-track Hip and Knee Replacement Database, based on the availability of genetic information, was included. Within these patients, the 5-SNP scores were calculated and their discriminatory performance was determined by c-statistic. Furthermore, the 5-SNP scores were added to a simple logistic prediction model containing clinical predictors to assess the added predictive value. Results7,753 THA and TKA procedures (6,798 patients) were included in this study. The c-statistics for the weighted and simple 5-SNP score were 0.50 (95% confidence interval [CI] 0.39 – 0.61) and 0.48 (95%CI 0.38 – 0.58), respectively. For the model with clinical predictors, the c-statistic was 0.67 (95%CI 0.56 – 0.77). Addition of either of the 5-SNP scores did not improve discrimination in this model. ConclusionsThese findings do not support genetic risk profiling in fast-track THA/TKA patients to predict VTE. Hence, efforts should be directed at optimizing prediction models with clinical predictors.