POBS-Card, a new score of severe bleeding after cardiac surgery: Construction and external validationCentral MessagePerspective
Emmanuel Besnier, MD, PhD,
Pierre Schmidely, MD,
Guillaume Dubois, MD,
Prisca Lemonne, MD,
Lucie Todesco, MD,
Chadi Aludaat, MD,
Thierry Caus, MD, PHD,
Jean Selim, MD, PhD,
Emmanuel Lorne, MD, PhD,
Osama Abou-Arab, MD, PhD
Affiliations
Emmanuel Besnier, MD, PhD
Department of Anesthesiology and Critical Care, Univ Rouen Normandie, Inserm U1096, CHU Rouen, Rouen, France; Address for reprints: Emmanuel Besnier, MD, PhD, Département d'Anesthésie-Réanimation, Chu Charles Nicolles, 1 Rue de Germont, 76031 Rouen, France.
Pierre Schmidely, MD
Department of Anesthesiology and Critical Care, CHU Rouen, Rouen, France
Guillaume Dubois, MD
Anesthesia and Critical Care Department, Amiens Hospital University, Amiens, France
Prisca Lemonne, MD
Department of Anesthesiology and Critical Care, CHU Rouen, Rouen, France
Lucie Todesco, MD
Department of Anesthesiology and Critical Care, CHU Rouen, Rouen, France
Chadi Aludaat, MD
Department of Cardiac Surgery, Rouen University Hospital, Rouen, France
Thierry Caus, MD, PHD
Department of Cardiac Surgery, Amiens University Hospital, Amiens, France
Jean Selim, MD, PhD
Department of Anesthesiology and Critical Care, Univ Rouen Normandie, Inserm U1096, CHU Rouen, Rouen, France
Emmanuel Lorne, MD, PhD
Anesthesia and Critical Care Medicine, Clinique du Millénaire, Cedex 2, Montpellier, France
Osama Abou-Arab, MD, PhD
Anesthesia and Critical Care Department, Amiens Hospital University, Amiens, France
Objective: Bleeding after cardiac surgery leads to poor outcomes. The objective of the study was to build the PeriOperative Bleeding Score in Cardiac surgery (POBS-Card) to predict bleeding after cardiac surgery. Methods: We conducted a retrospective cohort study in 2 academic hospitals (2016-2019). Inclusion criteria were adult patients after cardiac surgery under cardiopulmonary bypass. Exclusion criteria were heart transplantation, assistance, aortic dissection, and preoperative hemostasis diseases. Bleeding was defined by the universal definition for perioperative bleeding score ≥2. POBS-Card score was built using multivariate regression (derivation cohort, one center). The performance diagnosis was assessed using the area under the curve in a validation cohort (2 centers) and compared with other scores. Results: In total, 1704 patients were included in the derivation cohort, 344 (20%) with bleeding. Preoperative factors were body mass index 1.2 (OR, 1.44 [1.03-1.99]), prothrombin ratio 14 predicted bleeding with a sensitivity of 50% and a specificity of 73%. Conclusions: POBS-Card score was superior to other scores in predicting severe bleeding after cardiac surgery. Performances remained modest, questioning the place of these scores in the perioperative strategy of bleeding-sparing.
