Table 3.
Evidence profile for bleeding-related prognostic factors
| No. of studies | Certainty assessment domains | Overall certainty in the evidence about this prognostic factor | Relative effect (95% CI) | |||||
|---|---|---|---|---|---|---|---|---|
| Study design | Risk of bias | Indirect | Inconsistent | Imprecise | Publication bias | |||
| Age (≥65 vs <65)8,33 | ||||||||
| 2 | Observational | Serious*,† | Not serious | Not serious | Not serious | Undetected | ⊕⊕⊕○ | Age ≥65: OR, 1.95 (95% CI, 1.59-2.38) |
| MODERATE | ||||||||
| Sex (male vs female)8,33 | ||||||||
| 2 | Observational | Serious*,† | Not serious | Not serious | Not serious | Undetected | ⊕⊕⊕○ | OR, 1.27 (95% CI, 1.09-1.47). |
| MODERATE | ||||||||
| Anemia as a reason for admission (presence vs absence)34 | ||||||||
| 2 | Observational | Serious*,‡ | Not serious | Not serious | Not serious | Undetected | ⊕⊕⊕○ | OR, 5.15 (95% CI, 2.45-10.81) |
| MODERATE | ||||||||
| Morbid obesity (BMI ≥ 40 kg/m2 vs BMI < <40 kg/m2)34 | ||||||||
| 1 | Observational | Serious‡ | Not serious | Not serious | Not serious | Undetected | ⊕⊕⊕○ | OR, 3.08 (95% CI, 1.35-7.02) |
| MODERATE | ||||||||
| Low hemoglobin: defined as <13 g/dL in men and <11.5 g/dL in women (yes vs no)34 | ||||||||
| 1 | Observational | Serious‡ | Not serious | Not serious | Not serious | Undetected | ⊕⊕⊕○ | OR, 2.33 (95% CI, 1.04-5.22) |
| MODERATE | ||||||||
| Gastroduodenal ulcers (yes vs no)8,33 | ||||||||
| 2 | Observational | Serious*,† | Not serious | Not serious | Not serious | Undetected | ⊕⊕⊕○ | OR, 2.74 (95% CI, 1.42-5.26) |
| MODERATE | ||||||||
| Rehospitalization (yes vs no)33 | ||||||||
| 1 | Observational | Serious† | Not serious | Not serious | Not serious | Undetected | ⊕⊕⊕○ | OR, 2.39 (95% 2.25-2.54) |
| MODERATE | ||||||||
| Critical illness (yes vs no)8 | ||||||||
| 1 | Observational | Serious* | Not serious | Not serious | Not serious | Undetected | ⊕⊕⊕○ | OR, 2.10 (95% CI, 1.42-3.11). |
| MODERATE | ||||||||
| Thrombocytopenia (yes vs no)8,33,34 | ||||||||
| 3 | Observational | Serious*,†,‡ | Not serious | Not serious | Not serious | Undetected | ⊕⊕⊕○ | All: OR, 1.79 (95% CI, 0.97-3.29) |
| MODERATE | <50 × 109/L: OR, 3.37 (95% CI, 1.84-6.18) | |||||||
| <150 × 109/L: OR, 1.30 (95% CI, 0.92-1.82) | ||||||||
| Blood dyscrasias defined as the presence of any bleeding disorders on admission (presence vs absence)33 | ||||||||
| 1 | Observational | Serious† | Not serious | Not serious | Not serious | Undetected | ⊕⊕⊕○ | OR, 1.70 (95% CI, 1.60-1.81) |
| MODERATE | ||||||||
| Hepatic disease (yes vs no)8,33 | ||||||||
| 2 | Observational | Serious*,† | Not serious | Not serious | Not serious | Undetected | ⊕⊕⊕○ | OR, 1.53 (95% CI, 1.09-2.15) |
| MODERATE | ||||||||
| Renal failure (yes vs no)8,33 | ||||||||
| 2 | Observational | Serious*,† | Not serious | Not serious | Not serious | Undetected | ⊕⊕⊕○ | Total: OR, 1.43 (95% CI, 1.06-1.93) |
| MODERATE | Any renal failure (RF): OR, 1.23 (95% CI, 0.92-1.65). | |||||||
| Moderate RF (GFR 30-59 mL/min/m2): OR, 1.37(95% CI, 0.84-2.23) | ||||||||
| Severe RF (GFR <30 mL/min/m2): OR, 2.14 (95% CI, 1.22-3.75) | ||||||||
| Antithrombotic medication (yes vs no)8,33 | ||||||||
| 2 | Observational | Serious*,† | Not serious | Not serious | Not serious | Undetected | ⊕⊕⊕○ | OR, 1.28 (95% CI, 1.01-1.64) |
| MODERATE | ||||||||
| CVC (yes vs no)8,33 | ||||||||
| 2 | Observational | Serious*,† | Not serious | Not serious | Not serious | Undetected | ⊕⊕⊕○ | OR, 1.37 (95% CI, 0.83-2.26) |
| MODERATE | ||||||||
| Autoimmune disease (yes vs no)8 | ||||||||
| 2 | Observational | Serious* | Not serious | Not serious | Serious§ | Undetected | ⊕⊕○○ | OR, 1.30 (95% CI, 0.77-2.19) |
| LOW | ||||||||
| Hormone use: defined as estrogen intake (yes vs no)33 | ||||||||
| 1 | Observational | Serious† | Not serious | Not serious | Not serious | Undetected | ⊕⊕⊕○ | OR, 0.95 (95% CI, 0.82-1.10) |
| MODERATE | ||||||||
| Malignancy (yes vs no)8,33 | ||||||||
| 2 | Observational | Serious *,† | Not serious | Not serious | Serious§ | Undetected | ⊕⊕○○ | OR, 1.08 (95% CI, 0.42-2.77) |
| LOW | ||||||||
Question: prognostic factors for medical patients; outcome: bleeding; setting: inpatient.
Certainty in evidence was downgraded for risk of bias, given that patients were enrolled both prospectively and retrospectively in Decousus et al.8 The retrospective enrollment of patients may have introduced classification bias.
Certainty in evidence was downgraded for risk of bias, given that the authors evaluated bleeding risk in medical patients after hospitalization, that may overestimate the magnitude of the association. This is possibly due to patients being discharged on thromboprophylaxis without proper risk stratification for bleeding placing unmonitored patients at a higher risk of having a bleeding event.
Certainty in evidence was downgraded for risk of bias, given that the population is specific to hospitalized cancer patients who are at a higher risk of VTE and may be given thromboprophylaxis, placing them at a higher risk of having a bleeding event. This in turn may overestimate the magnitude of the association.
Certainty in evidence was downgraded for imprecision, given that the CI suggests that there may be no association.