Severe bleeding following off-pump coronary artery bypass grafting:predictive factors and risk model
Yu LIU1
Xing WANG2
Zi-Ying CHEN3
Wen-Li ZHANG3
Lin GUO4
Yong-Quan SUN3
Hong-Zhan CUI3
Ji-Qiang BU3
Jian-Hui CAI5
1.Department of Surgery,Hebei Medical University,Shijiazhuang,China;Department of Cardiac Surgery,the Second Hospital of Hebei Medical University,Shijiazhuang,China2.Department of Endocrinology,the Second Hospital of Hebei Medical University,Shijiazhuang,China3.Department of Cardiac Surgery,the Second Hospital of Hebei Medical University,Shijiazhuang,China4.School of Industrial and Systems Engineering,University of Oklahoma,Norman,USA5.Department of Surgery,Hebei Medical University,Shijiazhuang,China;Department of Surgery and Oncology,Hebei General Hospital,Shijiazhuang,China
摘要：BACKGROUND Severe bleeding following cardiac surgery remains a troublesome complication,but to date,there is a lack of comprehensive predictive models for the risk of severe bleeding following off-pump coronary artery bypass grafting (OPCABG).This study aims to analyze relevant indicators of severe bleeding after isolated OPCABG and establish a corresponding risk as-sessment model.METHODS The clinical data of 584 patients who underwent OPCABG from January 2018 to April 2020 were retrospectively analyzed.We gathered the preoperative baseline data and postoperative data immediately after intensive care unit admission and used multifactor logistic regression to screen the potential predictors of severe bleeding,upon which we established a pre-dictive model.Using the consistency index and calibration curve,decision curve,and clinical impact curve analysis,we evalu-ated the performance of the model.RESULTS This study is the first to establish a risk assessment and prediction model for severe bleeding following isolated OPCABG.Eight independent risk factors were identified:male sex,aspirin/clopidogrel withdrawal time,platelet count,fibrinogen level,C-reactive protein,serum creatinine,and total bilirubin.Among the 483 patients in the training group,138 patients (28.6％)had severe bleeding;among the 101 patients in the verification group,25 patients (24.8％) had severe bleeding.Receiver operat-ing characteristic (ROC) curve analysis for the internal training group revealed a convincing performance with a concordance index (C-index) of 0.859,while the area under the ROC curve for the external validation data was 0.807.Decision curve analysis showed that the model was useful for both groups.CONCLUSIONS Although there are some limitations,the model can effectively predict the probability of severe bleeding fol-lowing isolated OPCABG and is therefore worthy of further exploration and verification.
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论文发表日期：2021-06-28
在线出版日期：2025-08-15（本平台首次上网日期，不代表文献的发表时间）
页数：13( 449-461 )