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POBS-Card, a new score of severe bleeding after cardiac surgery: Construction and external validation
Emmanuel Besnier1, Pierre Schmidely2, Guillaume Dubois3
1Department of Anesthesiology and Critical Care, Univ Rouen Normandie, Inserm U1096, CHU Rouen, Rouen, France.
Insights
A new score, the PeriOperative Bleeding Score in Cardiac surgery (POBS-Card), was developed to predict bleeding after cardiac surgery. This score demonstrated superiority over existing methods in identifying patients at risk for severe bleeding.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Hematology
Background:
- Postoperative bleeding following cardiac surgery is a significant complication associated with adverse patient outcomes.
- Effective prediction of perioperative bleeding is crucial for implementing targeted interventions and improving patient safety.
Purpose of the Study:
- To develop and validate the PeriOperative Bleeding Score in Cardiac surgery (POBS-Card) for predicting severe bleeding events after cardiac surgical procedures.
Main Methods:
- A retrospective cohort study was conducted across two academic hospitals between 2016 and 2019.
- The POBS-Card score was derived using multivariate regression in a cohort of 1704 adult patients undergoing cardiac surgery, with bleeding defined by a universal definition score ≥2.
- Performance was validated in a separate cohort of 597 patients and compared against established bleeding prediction scores.
Main Results:
- The derivation cohort included 1704 patients, with 20% experiencing bleeding. Key predictors identified included low body mass index, specific surgical types (redo, combined, ascendant aorta), antiplatelet therapy, elevated activated thromboplastin time ratio, low prothrombin ratio, low platelet count, and low fibrinogen levels.
- In the validation cohort of 597 patients, the POBS-Card score achieved an area under the curve of 0.645, outperforming other scores like WILL-BLEED, Papworth, TRUST, and TRACK.
- A POBS-Card threshold of >14 predicted bleeding with 50% sensitivity and 73% specificity.
Conclusions:
- The POBS-Card score demonstrated superior performance compared to existing scores in predicting severe bleeding after cardiac surgery.
- Despite its improved accuracy, the overall performance of the POBS-Card score remains modest, prompting further evaluation of its role in perioperative bleeding management strategies.
Objective:
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.
Methods:
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.
Results:
In total, 1704 patients were included in the derivation cohort, 344 (20%) with bleeding. Preoperative factors were body mass index <25 kg/m2 (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%.
Conclusions:
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.
