title: Prediction of severe bleeding after coronary surgery: the WILL-BLEED Risk Score.
abstract: Severe perioperative bleeding after coronary artery bypass grafting (CABG) is associated with poor outcome. An additive score for prediction of severe bleeding was derived (n=2494) and validated (n=1250) in patients from the E-CABG registry. Severe bleeding was defined as E-CABG bleeding grades 2-3 (transfusion of >4 units of red blood cells or reoperation for bleeding). The overall incidence of severe bleeding was 6.4 %. Preoperative anaemia (3 points), female gender (2 points), eGFR <45 ml/min/1.73 m2(3 points), potent antiplatelet drugs discontinued less than five days (2 points), critical preoperative state (5 points), acute coronary syndrome (2 points), use of low-molecular-weight heparin/fondaparinux/unfractionated heparin (1 point) were independent predictors of severe bleeding. The WILL-BLEED score was associated with increasing rates of severe bleeding in both the derivation and validation cohorts (scores 0-3: 2.9 % vs 3.4 %; scores 4-6: 6.8 % vs 7.5 %; scores>6: 24.6 % vs 24.2 %, both p<0.0001). The WILL-BLEED score had a better discriminatory ability (AUC 0.725) for prediction of severe bleeding compared to the ACTION (AUC 0.671), CRUSADE (AUC 0.642), Papworth (AUC 0.605), TRUST (AUC 0.660) and TRACK (AUC 0.640) bleeding scores. The net reclassification index and integrated discrimination improvement using the WILL-BLEED score as opposed to the other bleeding scores were significant (p<0.0001). The decision curve analysis demonstrated a net benefit with the WILL-BLEED score compared to the other bleeding scores. In conclusion, the WILL-BLEED risk score is a simple risk stratification method which allows the identification of patients at high risk of severe bleeding after CABG.
authors.affiliation: Prof. Fausto Biancari, Department of Surgery, Oulu University Hospital, PL 21, 90029 Oulu, Finland, Tel.: +358 40 7333 973, Fax: +358 8 315 2486, E-mail: faustobiancari@yahoo.it.
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
authors.forename: Debora
authors.initials: D
authors.lastname: Brascia
authors.forename: Francesco
authors.initials: F
authors.lastname: Onorati
authors.forename: Daniel
authors.initials: D
authors.lastname: Reichart
authors.forename: Andrea
authors.initials: A
authors.lastname: Perrotti
authors.forename: Vito G
authors.initials: VG
authors.lastname: Ruggieri
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Santarpino
authors.forename: Daniele
authors.initials: D
authors.lastname: Maselli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mariscalco
authors.forename: Riccardo
authors.initials: R
authors.lastname: Gherli
authors.forename: Antonino S
authors.initials: AS
authors.lastname: Rubino
authors.forename: Marisa
authors.initials: M
authors.lastname: De Feo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gatti
authors.forename: Francesco
authors.initials: F
authors.lastname: Santini
authors.forename: Magnus
authors.initials: M
authors.lastname: Dalén
authors.forename: Matteo
authors.initials: M
authors.lastname: Saccocci
authors.forename: Eeva-Maija
authors.initials: EM
authors.lastname: Kinnunen
authors.forename: Juhani K E
authors.initials: JK
authors.lastname: Airaksinen
authors.forename: Paola
authors.initials: P
authors.lastname: D'Errigo
authors.forename: Stefano
authors.initials: S
authors.lastname: Rosato
authors.forename: Francesco
authors.initials: F
authors.lastname: Nicolini
mesh_terms: D000368:Aged; D019540:Area Under Curve; D000066491:Clinical Decision-Making; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D003324:Coronary Artery Disease / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D003661:Decision Support Techniques; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000401:mortality; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012042:Registries; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: Bleeding; CABG; cardiac surgery; coronary artery bypass grafting; risk score