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Multicenter Study
. 2021 Nov;52(4):1032-1035.
doi: 10.1007/s11239-021-02504-5. Epub 2021 Jun 19.

External validation of the IMPROVE-DD risk assessment model for venous thromboembolism among inpatients with COVID-19

Mark Goldin #  1   2   3 , Stephanie K Lin #  1 , Nina Kohn  2 , Michael Qiu  4 , Stuart L Cohen  1   2 , Matthew A Barish  3 , Eugenia Gianos  1   5 , Anise Diaz  1 , Safiya Richardson  1   2 , Dimitrios Giannis  2 , Saurav Chatterjee  1   3 , Kevin Coppa  4 , Jamie S Hirsch  1   2   4 , Sam Ngu  6 , Sheila Firoozan  6 , Thomas McGinn  7 , Alex C Spyropoulos  8   9
Affiliations
Multicenter Study

External validation of the IMPROVE-DD risk assessment model for venous thromboembolism among inpatients with COVID-19

Mark Goldin et al. J Thromb Thrombolysis. 2021 Nov.

Abstract

There is a need to discriminate which COVID-19 inpatients are at higher risk for venous thromboembolism (VTE) to inform prophylaxis strategies. The IMPROVE-DD VTE risk assessment model (RAM) has previously demonstrated good discrimination in non-COVID populations. We aimed to externally validate the IMPROVE-DD VTE RAM in medical patients hospitalized with COVID-19. This retrospective cohort study evaluated the IMPROVE-DD VTE RAM in adult patients with COVID-19 admitted to one of thirteen Northwell Health hospitals in the New York metropolitan area between March 1, 2020 and April 27, 2020. VTE was defined as new-onset symptomatic deep venous thrombosis or pulmonary embolism. To assess the predictive value of the RAM, the receiver operating characteristic (ROC) curve was plotted and the area under the curve (AUC) was calculated. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Of 9407 patients who met study criteria, 274 patients developed VTE with a prevalence of 2.91%. The VTE rate was 0.41% for IMPROVE-DD score 0-1 (low risk), 1.21% for score 2-3 (moderate risk), and 5.30% for score ≥ 4 (high risk). Approximately 45.7% of patients were classified as high VTE risk, 33.3% moderate risk, and 21.0% low risk. Discrimination of low versus moderate-high VTE risk demonstrated sensitivity 0.971, specificity 0.215, PPV 0.036, and NPV 0.996. ROC AUC was 0.703. In this external validation study, the IMPROVE-DD VTE RAM demonstrated very good discrimination to identify hospitalized COVID-19 patients at low, moderate, and high VTE risk.

Keywords: COVID-19; Deep venous thrombosis; IMPROVE-DD; Pulmonary embolism; ROC curve; Risk assessment; Venous thromboembolism.

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Conflict of interest statement

ACS is a consultant for Boehringer Ingelheim, Janssen, Bayer, Bristol Myers Squibb, and Portola. No other authors have stated conflicts of interest.

Figures

Fig. 1
Fig. 1
Logistic regression with receiver operating characteristic curve for inpatient VTE for IMPROVE-DD score
See this image and copyright information in PMC

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