机构：[1]The First Bethune Hospital of Jilin University, Jilin University, Changchun, China[2]National Center for Respiratory Medicinestate Key Laboratory of Respiratory Health and Multimorbiditynational Clinical Research Center for Respiratory Diseasesinstitute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China[3]China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China[4]Department of Pulmonary and Critical Care Medicine, Guizhou Provincial People’s Hospital, Guiyang, China[5]Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China[6]Beijing University of Chinese Medicine China-Japan Friendship School of Clinical Medicine, Beijing, China[7]Department of Pulmonary and Critical Care Medicine, The First People’s Hospital of Yinchuan, Yinchuan, China[8]Department of Pulmonary and Critical Care Medicine, Taizhou First People’s Hospital, Taizhou, China[9]Department of Pulmonary and Critical Care Medicine,First People’s Hospital of Yunnan Province,Yunnan,China内科片外科片呼吸与危重症医学科重症医学科云南省第一人民医院[10]Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China[11]Department of Pulmonary and Critical Care Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing, China首都医科大学附属安贞医院[12]Department of Physiology, State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, School of Basic Medicine Peking, Chinese Academy of Medical Sciences, Union Medical College, Beijing 100005, China
BackgroundCOVID-19 patients are at increased risk of thrombosis and bleeding, but no standardized bleeding risk assessment tool has been recommended.ObjectiveThis study evaluates the predictive value of the IMPROVE Bleeding Risk Score (BRS) in hospitalized COVID-19 patients.DesignA multicenter, prospective cohort of 3,886 hospitalized COVID-19 patients across six tertiary hospitals in China between December 1, 2022, and January 31, 2023.ParticipantsPatients were objectively diagnosed with COVID-19 by pathogen or antibody detection and followed for 90 days.Main MeasuresThe primary outcomes were major bleeding (MB) and clinically relevant non-major bleeding (CRNMB). We evaluated the IMPROVE BRS predictive performance using hazard ratios (HRs), positive and negative predictive values, the area under the receiver operating characteristic curve (AUC), and calibration.Key ResultsAmong 3,886 hospitalized COVID-19 patients (median age 74, IQR 62-84), 42 MB (1.1%) and 47 CRNMB (1.2%) events occurred within 90 days. The IMPROVE BRS performed well in predicting MB events, with an AUC of 0.84 (95% CI, 0.77-0.91) at 90 days. Calibration plots indicated good calibration. High-risk patients had a significantly higher bleeding risk than low-risk patients, even after adjusting for low molecular weight heparin (LMWH) thromboprophylaxis (MB: adjusted HR 6.63, 95% CI 3.62-12.15; CRNMB: adjusted HR 3.69, 95% CI 2.04-6.71). Subgroup analysis indicated that LMWH thromboprophylaxis significantly increased MB risk in elderly patients with high bleeding risk (14 days: adjusted HR 5.45, 95% CI 1.15-25.94; 30 days: adjusted HR 4.16, 95% CI 1.11-15.53).ConclusionsThe IMPROVE BRS effectively predicted MB risk in COVID-19 patients and provided valuable guidance for LMWH thromboprophylaxis in elderly patients. Further research is needed to validate its applicability in different populations and refine threshold values for improved predictive accuracy.
基金：
Fund of CAMS Innovation Fund for Medical Sciences (CIFMS) [2023-I2M-CT-A-014]; Fund of National High Level Hospital Clinical Research Funding [2022-NHLHCRF-LX-01-0108]; CAMS Innovation Fund for Medical Sciences (CIFMS) [2021-I2M-1-061, 2021-I2M-1- 049]; National Key Research and Development Program of China [2023YFC2507200]; National High Level Hospital Clinical Research Funding [2024-NHLHCRF-JBGS-WZ-09]; Project of China-Japan Friendship Hospital [ZRJY2023-QM20]
语种：
外文
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PubmedID：
中科院(CAS)分区：
出版当年[2025]版：
无
最新[2025]版：
大类|2 区医学
小类|2 区医学：内科3 区卫生保健与服务
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出版当年[2024]版：
无
最新[2023]版：
Q1HEALTH CARE SCIENCES & SERVICESQ1MEDICINE, GENERAL & INTERNAL
第一作者机构：[1]The First Bethune Hospital of Jilin University, Jilin University, Changchun, China[2]National Center for Respiratory Medicinestate Key Laboratory of Respiratory Health and Multimorbiditynational Clinical Research Center for Respiratory Diseasesinstitute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
共同第一作者：
通讯作者：
通讯机构：[1]The First Bethune Hospital of Jilin University, Jilin University, Changchun, China[2]National Center for Respiratory Medicinestate Key Laboratory of Respiratory Health and Multimorbiditynational Clinical Research Center for Respiratory Diseasesinstitute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
推荐引用方式(GB/T 7714)：
Tao Yuzhi,Xu Feiya,Han Jing,et al.External Validation of the IMPROVE Risk Score for Predicting Bleeding in Hospitalized COVID-19 Patients[J].JOURNAL OF GENERAL INTERNAL MEDICINE.2025,doi:10.1007/s11606-025-09431-8.
APA：
Tao, Yuzhi,Xu, Feiya,Han, Jing,Deng, Chaosheng,Liang, Rui...&Zhai, Zhenguo.(2025).External Validation of the IMPROVE Risk Score for Predicting Bleeding in Hospitalized COVID-19 Patients.JOURNAL OF GENERAL INTERNAL MEDICINE,,
MLA：
Tao, Yuzhi,et al."External Validation of the IMPROVE Risk Score for Predicting Bleeding in Hospitalized COVID-19 Patients".JOURNAL OF GENERAL INTERNAL MEDICINE .(2025)
