Construction of Bleeding Risk Prediction Model for Patients with Non-valvular Atrial Fibrillation after Taking Dabigatran Etexilate
Objective To analyze the related factors of bleeding risk in patients with non-valvular atrial fibrillation after taking dabigatran etexilate and to construct a risk prediction model.Methods A total of 187 patients with non-valvular atrial fibrillation admitted to Jiujiang First People's Hospital from June 2020 to June 2023 were selected as the study subjects.They were divided into bleeding group(n=50)and non-bleeding group(n=137)according to whether bleeding occurred.Logistic regression was used to construct a predictive risk model,and receiver operating curve(ROC)and Homster-Lemeshow goodness-of-fit test(H-L)were used to evaluate the performance of the model.The clinical data of 50 patients with non-valvular atrial fibrillation were selected for external validation of the model.Results The probability of bleeding in 187 patients with non-valvular atrial fibrillation was 26.74%.According to single factor and Logistic multivariate analysis,high dose of dabigatran etexilate,HAS-BLED score,APTT and D-D were risk factors for bleeding in patients with non-valvular atrial fibrillation,and high level of creatinine clearance rate(Ccr)was a protective factor.The results of internal validation H-L test showed that χ2=2.23,P>0.05,and the model fitting was good.The area under the ROC curve was 0.811(P<0.001,95%CI 0.738-0.883),the sensitivity was 76.00%,the specificity was 78.10%,and the maximum Youden index was 0.541.In addition,the clinical data of 50 patients were selected.The results of H-L test showed that χ2=4.97,P>0.05,and the model fitting was good.The area under the ROC curve was 0.888(P<0.001,95%CI 0.797-0.980),the sensitivity was 76.70%,the specificity was 95.00%,and the maximum Youden index was 0.717.Conclusion High dose of dabigatran etexilate,HAS-BLED score,APTT and D-D are risk factors for bleeding in patients with non-valvular atrial fibrillation,and high level of Ccr is a protective factor.The established risk early warning model has good predictive efficacy and can be used for early prediction of bleeding risk in patients with non-valvular atrial fibrillation after taking dabigatran etexilate.
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