Giovanni Mariscalco1, Riccardo Gherli2, Aamer B Ahmed3, Marco Zanobini4, Daniele Maselli5, Magnus Dalén6, Gabriele Piffaretti7, Giangiuseppe Cappabianca8, Cesare Beghi8, Fausto Biancari9. 1. Department of Cardiovascular Sciences, Clinical Sciences Wing, University of Leicester, Glenfield Hospital, Leicester, United Kingdom. Electronic address: giovannimariscalco@yahoo.it. 2. Department of Cardiovascular Science, Cardiac Surgery Unit, S. Camillo-Forlanini Hospital, Rome, Italy. 3. Department of Anaesthesia and Critical Care, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom. 4. Department of Cardiovascular Sciences, Cardiac Surgery, Centro Cardiologico Monzino IRCCS, University of Milan, Milan, Italy. 5. Department of Cardiovascular Surgery, Cardiac Surgery Unit, S. Anna Hospital Catanzaro, Italy. 6. Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. 7. Department of Surgical and Morphological Sciences, Vascular Surgery Unit, Varese University Hospital, University of Insubria, Varese, Italy. 8. Department of Surgical and Morphological Sciences, Cardiac Surgery Unit, Varese University Hospital, University of Insubria, Varese, Italy. 9. Department of Surgery, University of Oulu, Oulu, Finland.
Abstract
BACKGROUND: This study evaluated the prognostic significance of a novel bleeding severity classification in adult patients undergoing cardiac operations. METHODS: The European multicenter study on Coronary Artery Bypass Grafting (E-CABG) bleeding severity classification proposes 4 grades of postoperative bleeding: grade 0, no need of blood products with the exception of 1 unit of red blood cells (RBCs); grade 1, transfusion of platelets, plasma, or 2 to 4 units of RBCs, or both; grade 2, transfusion of 5 to 10 units of RBCs or reoperation for bleeding, or both; grade 3, transfusion of more than 10 units of RBCs. This classification was tested in a cohort of 7,491 patients undergoing CABG or valve operations, or combined procedures. RESULTS: The E-CABG bleeding severity grading method was an independent predictor of in-hospital death, stroke, acute kidney injury, renal replacement therapy, deep sternal wound infection, atrial fibrillation, intensive care unit stay of 5 days or more, and composite adverse events of death, stroke, renal replacement therapy, and intensive care unit stay of 5 days or more. The area under the receiver operating characteristic curve of the E-CABG bleeding severity grading method for predicting in-hospital death was 0.858 (95% confidence interval, 0.827 to 0.889). E-CABG bleeding severity grades 0 to 3 were associated with in-hospital mortality rates of 0.2%, 1.1%, 7.9%, and 29.0%, respectively (p <0.001), and with composite adverse events of 2.7%, 9.6%, 29.7%, and 75.8%, respectively (p <0.001). CONCLUSIONS: The E-CABG bleeding severity classification seems to be a valuable tool in the assessment of the severity and prognostic effect of perioperative bleeding in cardiac operations.
BACKGROUND: This study evaluated the prognostic significance of a novel bleeding severity classification in adult patients undergoing cardiac operations. METHODS: The European multicenter study on Coronary Artery Bypass Grafting (E-CABG) bleeding severity classification proposes 4 grades of postoperative bleeding: grade 0, no need of blood products with the exception of 1 unit of red blood cells (RBCs); grade 1, transfusion of platelets, plasma, or 2 to 4 units of RBCs, or both; grade 2, transfusion of 5 to 10 units of RBCs or reoperation for bleeding, or both; grade 3, transfusion of more than 10 units of RBCs. This classification was tested in a cohort of 7,491 patients undergoing CABG or valve operations, or combined procedures. RESULTS: The E-CABG bleeding severity grading method was an independent predictor of in-hospital death, stroke, acute kidney injury, renal replacement therapy, deep sternal wound infection, atrial fibrillation, intensive care unit stay of 5 days or more, and composite adverse events of death, stroke, renal replacement therapy, and intensive care unit stay of 5 days or more. The area under the receiver operating characteristic curve of the E-CABG bleeding severity grading method for predicting in-hospital death was 0.858 (95% confidence interval, 0.827 to 0.889). E-CABG bleeding severity grades 0 to 3 were associated with in-hospital mortality rates of 0.2%, 1.1%, 7.9%, and 29.0%, respectively (p <0.001), and with composite adverse events of 2.7%, 9.6%, 29.7%, and 75.8%, respectively (p <0.001). CONCLUSIONS: The E-CABG bleeding severity classification seems to be a valuable tool in the assessment of the severity and prognostic effect of perioperative bleeding in cardiac operations.
Authors: Jill M Cholette; Jennifer A Muszynski; Juan C Ibla; Sitaram Emani; Marie E Steiner; Adam M Vogel; Robert I Parker; Marianne E Nellis; Melania M Bembea Journal: Pediatr Crit Care Med Date: 2022-01-01 Impact factor: 3.971
Authors: Philip C Spinella; Nahed El Kassar; Andrew P Cap; Andrei L Kindzelski; Christopher S Almond; Alan Barkun; Terry B Gernsheimer; Joshua N Goldstein; John B Holcomb; Alfonso Iorio; Dennis M Jensen; Nigel S Key; Jerrold H Levy; Stephan A Mayer; Ernest E Moore; Simon J Stanworth; Roger J Lewis; Marie E Steiner Journal: J Trauma Acute Care Surg Date: 2021-08-01 Impact factor: 3.697