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Comparison of scoring systems for bleeding in open cardiac surgery patients
İpek Yakin1, Çağrı Düzyol2, İlke Dolğun3
1Department of Anesthesiology and Reanimation, Kocaeli City Hospital, Kocaeli, Turkiye.
Insights
The TRUST scoring system best predicts the need for erythrocyte suspension (ES) transfusions in open-heart surgery patients. Other systems like WILL-BLEED, TRACK, ACTION, and ACTA-PORT also show predictive value for perioperative bleeding risk.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Hematology
Background:
- Perioperative bleeding is a significant risk in open-heart surgery.
- Accurate prediction of transfusion needs is crucial for patient management.
- Existing bleeding risk scoring systems require evaluation for sensitivity in this context.
Purpose of the Study:
- To compare the sensitivity of seven preoperative bleeding risk scoring systems.
- To identify the most effective system for predicting perioperative erythrocyte suspension (ES) transfusion requirements in open-heart surgery patients.
Main Methods:
- Retrospective single-center cohort study.
- Evaluation of seven scoring systems: TRACK, PAPWORTH, WILL-BLEED, CRUSADE, ACTION, TRUST, ACTA-PORT.
- Analysis of transfusion requirements in 400 open-heart surgery patients.
Main Results:
- Patients requiring ES had higher age, creatinine, diabetes mellitus, and hypertension.
- Lower ejection fraction, hemoglobin, and hematocrit levels were observed in patients needing ES.
- The TRUST scoring system demonstrated the highest predictive value for ES use, followed by ACTION and ACTA-PORT.
Conclusions:
- The TRUST, WILL-BLEED, and TRACK systems are highly predictive of bleeding and transfusion needs in coronary artery bypass grafting (CABG) operations.
- Low ejection fraction, hemoglobin, hematocrit, elevated creatinine, and diabetes mellitus are independent risk factors for perioperative bleeding.
- Risk stratification using validated scoring systems can optimize transfusion strategies in cardiac surgery.
Background/Aim:
The aim of our study was to determine which preoperative bleeding risk scoring system is more sensitive in predicting perioperative transfusion requirement in patients undergoing open-heart surgery.
Materials And Methods:
This is a retrospective single-center cohort study. Seven scoring systems (TRACK, PAPWORTH, WILL-BLEED, CRUSADE, ACTION, TRUST, ACTA-PORT) were used to predict the likelihood of perioperative erythrocyte suspension (ES) transfusion requirement.
Results:
Four hundred patients were enrolled in the study. Age, creatinine level, and diagnoses of diabetes mellitus and hypertension were significantly higher in patients who required ES (p < 0.05). In addition, ejection fraction percentages and hemoglobin and hematocrit levels were significantly lower (p < 0.05). Except for PAPWORTH; ACTION, ACTA-PORT, WILL-BLEED, TRACK, TRUST, and CRUSADE scores were higher in the ES group (p < 0.05), but the most predictive scoring system for ES use was TRUST.
Conclusion:
The ACTION and ACTA-PORT systems were also found to significantly predict ES use, but the WILL-BLEED, TRUST, and TRACK systems were found to be more predictive of bleeding and ES transfusion requirement in CABG operations. Furthermore, low EF, Hb, and Hct levels, higher creatinine levels, and the presence of DM were identified as individual risk factors for perioperative bleeding, apart from the scoring systems.
