title: Validation of the European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG) Bleeding Severity Definition.
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.
authors.affiliation: Department of Cardiovascular Sciences, Clinical Sciences Wing, University of Leicester, Glenfield Hospital, Leicester, United Kingdom. Electronic address: giovannimariscalco@yahoo.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mariscalco
authors.affiliation: Department of Cardiovascular Science, Cardiac Surgery Unit, S. Camillo-Forlanini Hospital, Rome, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Gherli
authors.affiliation: Department of Anaesthesia and Critical Care, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.
authors.forename: Aamer B
authors.initials: AB
authors.lastname: Ahmed
authors.affiliation: Department of Cardiovascular Sciences, Cardiac Surgery, Centro Cardiologico Monzino IRCCS, University of Milan, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Zanobini
authors.affiliation: Department of Cardiovascular Surgery, Cardiac Surgery Unit, S. Anna Hospital Catanzaro, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Maselli
authors.affiliation: Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Dalén
authors.affiliation: Department of Surgical and Morphological Sciences, Vascular Surgery Unit, Varese University Hospital, University of Insubria, Varese, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Piffaretti
authors.affiliation: Department of Surgical and Morphological Sciences, Cardiac Surgery Unit, Varese University Hospital, University of Insubria, Varese, Italy.
authors.forename: Giangiuseppe
authors.initials: G
authors.lastname: Cappabianca
authors.affiliation: Department of Surgical and Morphological Sciences, Cardiac Surgery Unit, Varese University Hospital, University of Insubria, Varese, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Beghi
authors.affiliation: Department of Surgery, University of Oulu, Oulu, Finland.
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology; D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000209:etiology; D001803:Blood Transfusion / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006488:Hemostasis, Surgical / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D019106:Postoperative Hemorrhage / Q000145:classification* / Q000209:etiology / Q000628:therapy; D011379:Prognosis; D057216:Propensity Score; D012372:ROC Curve; D012086:Reoperation; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology