cliot (version 1.0.0)

improve_bleeding_risk_score: IMPROVE Bleeding Risk Score

Description

Calculates the IMPROVE Bleeding Risk Score to estimate the probability of major or clinically relevant non-major bleeding within 14 days of hospital admission in acutely ill medical patients. This score helps balance the risk of bleeding against the benefit of VTE prophylaxis.

Usage

improve_bleeding_risk_score(age, sex, gfr, active_cancer, rheumatic_disease,
                            central_venous_catheter, icu_ccu_admission,
                            hepatic_failure_inr_gt_1_5, platelet_count_lt_50,
                            prior_bleeding_3mo, active_gastroduodenal_ulcer)

Value

A list containing:

IMPROVE_Bleeding_Score

The calculated total score (Range 0-30.5+).

Risk_Category

Classification (Low < 7, High >= 7).

Bleeding_Probability_14_Days

Estimated probability of any bleeding event within 14 days.

Arguments

age

Numeric. Patient age in years.

sex

String. Patient sex ("Male" or "Female").

gfr

Numeric. Glomerular Filtration Rate (mL/min/1.73m^2).

active_cancer

Numeric (0 or 1). Active malignancy (excluding non-melanoma skin cancer) diagnosed or treated within the last 6 months.

rheumatic_disease

Numeric (0 or 1). History of rheumatic disease (e.g., RA, SLE).

central_venous_catheter

Numeric (0 or 1). Presence of a central venous catheter.

icu_ccu_admission

Numeric (0 or 1). Admission to an Intensive Care Unit (ICU) or Coronary Care Unit (CCU).

hepatic_failure_inr_gt_1_5

Numeric (0 or 1). Liver failure defined as INR > 1.5.

platelet_count_lt_50

Numeric (0 or 1). Thrombocytopenia (Platelet count < 50 x 10^9/L).

prior_bleeding_3mo

Numeric (0 or 1). Bleeding event within the 3 months prior to admission.

active_gastroduodenal_ulcer

Numeric (0 or 1). Active gastroduodenal ulcer.

Details

Scoring Weights: Active Gastroduodenal Ulcer: +4.5 Prior Bleeding (<3mo): +4.0 Platelets < 50k: +4.0 Age >= 85: +3.5 Hepatic Failure (INR>1.5): +2.5 GFR < 30: +2.5 ICU/CCU: +2.5 CVC: +2.0 Rheumatic Disease: +2.0 Active Cancer: +2.0 Age 40-84: +1.5 Male Sex: +1.0 GFR 30-59: +1.0

References

Decousus H, Tapson VF, Bergmann JF, et al. Factors at admission associated with bleeding risk in medical patients: findings from the IMPROVE investigators. Chest. 2011;139(1):69-79. doi:10.1378/chest.09-3081

Examples

# Example 1: High Risk
# Ulcer (+4.5), Male (+1.0), Age 45 (+1.5), GFR 40 (+1.0)
# Score = 8.0
improve_bleeding_risk_score(45, "male", 40, 0, 0, 0, 0, 0, 0, 0, 1)

# Example 2: Low Risk
# Female, Age 30, No risk factors
# Score = 0
improve_bleeding_risk_score(30, "female", 90, 0, 0, 0, 0, 0, 0, 0, 0)