Which are the best scores for prediction of severe bleeding after coronary artery bypass surgery?

BACKGROUND:Major bleeding after coronary artery bypass surgery(CABG) is an harmful event. Recently new scores for prediction of severe bleeding have been developed. METHODS:A multicenter observational study included 1391 consecutive patients who underwent isolated CABG from July 2015 to January 2018 In the present study we tested the hypothesis that the WILL-BLEED score, specifically designed for CABG, would perform at least as well as the CRUSADE, PAPWORTH, TRUST, TRACK and ACTION scores in predicting postoperative major bleeding. The primary endpoint was major bleeding after CABG procedure. The main secondary endopoint was in-hospital mortality. RESULTS:Mean blood losses in the first 12 post-operative hours was 339.75±189.97mL. 73(5.2%) subjects underwent administration of blood products and 1.3±1.5 units of red blood cells per patient were transfused. 1.6% of patients required at least one unit of fresh frozen plasma. The rate of severe-massive bleeding according to Universal Definition of Perioperative Bleeding(UDPB grades 3-4) classification was 1.5%. WILL-BLEED (OR 1.212, 95%CI 1.127-1.302, p value<0.001), TRUST (OR 1.481, 95%CI 1.252-1.754, p value<0.001) , TRACK (OR 1.079, 95%CI 1.036-1.122, p value<0.001) and ACTION (OR 1.045, 95%CI 1.007-1.083, p value= 0.018) scores were significantly associated with severe postoperative bleeding. C-index of these four bleeding schemes were 0.658, 0.648, 0.605 and 0.565 respectively. Reclassification analysis showed a worsening in sensitivity and significant negative reclassification of CRUSADE, PAPWORTH and TRACK and ACTION scores when compared with the WILL-BEED, based on Hosmer-Lemeshow test, IDI and NRI values. Overall in-hospital mortality was 1.65%. In-hospital mortality in patients with severe vs no-severe bleeding was found to be 11.8% vs 1.0% (p <0.0001). Severe bleeding (OR: 13.26; p<0.001) was found to be significantly associated with early mortality. CONCLUSIONS:In our cohort of CABG patients WILL-BLEED and TRUST scores resulted to be superior than the other scores for severe bleeding prediction. Furthermore severe bleeding correlated with early mortality.