Besnier Emmanuel, Schmidely Pierre, Dubois Guillaume, Lemonne Prisca, Todesco Lucie, Aludaat Chadi, Caus Thierry, Selim Jean, Lorne Emmanuel, Abou-Arab Osama
Department of Anesthesiology and Critical Care, Univ Rouen Normandie, Inserm U1096, CHU Rouen, Rouen, France.
Department of Anesthesiology and Critical Care, CHU Rouen, Rouen, France.
JTCVS Open. 2024 Apr 23;19:183-199. doi: 10.1016/j.xjon.2024.04.008. eCollection 2024 Jun.
Bleeding after cardiac surgery leads to poor outcomes. The objective of the study was to build the PeriOperative Bleeding Score in Cardiac surgery (POBS-Card) to predict bleeding after cardiac surgery.
We conducted a retrospective cohort study in 2 academic hospitals (2016-2019). Inclusion criteria were adult patients after cardiac surgery under cardiopulmonary bypass. Exclusion criteria were heart transplantation, assistance, aortic dissection, and preoperative hemostasis diseases. Bleeding was defined by the universal definition for perioperative bleeding score ≥2. POBS-Card score was built using multivariate regression (derivation cohort, one center). The performance diagnosis was assessed using the area under the curve in a validation cohort (2 centers) and compared with other scores.
In total, 1704 patients were included in the derivation cohort, 344 (20%) with bleeding. Preoperative factors were body mass index <25 kg/m (odds ratio [OR], 1.48 [1.14-1.93]), type of surgery (redo: OR, 1.76 [1.07-2.82]; combined: OR, 1.81 [1.19-2.74]; ascendant aorta: OR, 1.56 [1.02-2.38]), ongoing antiplatelet therapy (single: OR, 1.50 [1.09-2.05]; double: OR, 2.00 [1.15-3.37]), activated thromboplastin time ratio >1.2 (OR, 1.44 [1.03-1.99]), prothrombin ratio <60% (OR, 1.91 [1.21-2.97]), platelet count <150 g/L (OR, 1.74 [1.17-2.57]), and fibrinogen <3 g/L (OR, 1.33 [1.02-1.73]). In the validation cohort of 597 patients, the area under the curve was 0.645 [0.605-0.683] and was superior to other scores (WILL-BLEED, Papworth, TRUST, TRACK). A threshold >14 predicted bleeding with a sensitivity of 50% and a specificity of 73%.
POBS-Card score was superior to other scores in predicting severe bleeding after cardiac surgery. Performances remained modest, questioning the place of these scores in the perioperative strategy of bleeding-sparing.
心脏手术后出血会导致不良预后。本研究的目的是构建心脏手术围手术期出血评分（POBS-Card）以预测心脏手术后的出血情况。
我们在2家学术医院进行了一项回顾性队列研究（2016 - 2019年）。纳入标准为接受体外循环心脏手术的成年患者。排除标准为心脏移植、辅助循环、主动脉夹层和术前止血疾病。出血定义为围手术期出血评分通用定义≥2。POBS-Card评分通过多因素回归构建（推导队列，一个中心）。在验证队列（2个中心）中使用曲线下面积评估诊断性能，并与其他评分进行比较。
推导队列共纳入1704例患者，其中344例（20%）发生出血。术前因素包括体重指数<25kg/m²（比值比[OR]，1.48[1.14 - 1.93]）、手术类型（再次手术：OR，1.76[1.07 - 2.82]；联合手术：OR，1.81[1.19 - 2.74]；升主动脉手术：OR，1.56[1.02 - 2.38]）、正在进行抗血小板治疗（单一药物：OR，1.50[1.09 - 2.05]；双重药物：OR，2.00[1.15 - 3.37]）、活化部分凝血活酶时间比值>1.2（OR，1.44[1.03 - 1.99]）、凝血酶原比值<60%（OR，1.91[1.21 - 2.97]）、血小板计数<150×10⁹/L（OR，1.74[1.17 - 2.57]）和纤维蛋白原<3g/L（OR，1.33[1.02 - 1.73]）。在597例患者的验证队列中，曲线下面积为0.645[0.605 - 0.683]，优于其他评分（WILL - BLEED、Papworth、TRUST、TRACK）。阈值>14预测出血的敏感性为50%，特异性为73%。
POBS-Card评分在预测心脏手术后严重出血方面优于其他评分。但其性能仍较为一般，这对这些评分在围手术期出血 sparing策略中的地位提出了质疑。
