Qbleed Score in an African American Cohort

Introduction/Background:

The Qbleed score is an algorithm that calculates the absolute risk of gastrointestinal and intracranial bleed in patients on anticoagulation that was published in the British Medical Journal in July 2014.

It was developed using a UK general practice database. African Americans were not represented in the development of the algorithm. We intended to investigate if the score is applicable to African Americans.

Materials and Methods:

Our retrospective cohort study was conducted at Albert Einstein Medical Center in Philadelphia, USA. The study’s duration was 7 years between 1 January 2007 and 31 December 2014. Inclusion criteria to our study were African Americans admitted to the hospital for gastrointestinal bleeding (GIB) event requiring an esophagogastroduodenoscopy (EGD) or for an intracranial hemorrhage (ICH) event. Study participants on anticoagulants were identified by chart review. The Qbleed score of African Americans on anticoagulation admitted for GIB and ICH was calculated at the time of study entrance and compared with a control group; the control group was African Americans on anticoagulation that did not experience any of the above bleeding events.

Results:

1288 study participants were admitted for a GIB event requiring EGD. Of these, 107 (8.3%) were on anticoagulants.

The average Qbleed value in this group was 1.36 compared to 0.78 in the control group. On average, this group had 0.57 higher Qbleed score than controls (95% confidence interval 0.13 to 1.01, p=0.01). The receiver operating curve statistic value was 0.6698 (95% confidence interval 0.60 to 0.74).

1169 study participants were admitted for an ICH event. Of these 59 (5%) were on anticoagulants.

The average Qbleed value in this group was 0.85 compared to 0.48 in the control group. On average, this group had 0.36 higher Qbleed score than controls (95% confidence interval 0.16 to 0.57, p=0.0004). The receiver operating curve statistic value was 0.65 (95% confidence interval 0.56 to 0.74).

Conclusion:

In our African American cohort the absolute risk of gastrointestinal and intracranial bleeding calculated by the Qbleed score was significantly higher in patients who experienced a bleeding event. Our study suggests that the application of the Qbleed score to African Americans allows the identification of patients with higher risk of bleeding while on anticoagulation.