Details

Autor(en) / Beteiligte

• Yin, Michael Yaoyao
• Ruckel, Shane
• Kfoury, Abdallah G
• McKellar, Stephen H
• Taleb, Iosef
• Gilbert, Edward M
• Nativi-Nicolau, Jose
• Stehlik, Josef
• Reid, Bruce B
• Koliopoulou, Antigone
• Stoddard, Gregory J
• Fang, James C
• Drakos, Stavros G
• Selzman, Craig H
• Wever-Pinzon, Omar

Titel

Novel Model to Predict Gastrointestinal Bleeding During Left Ventricular Assist Device Support

Ist Teil von

• Circulation. Heart failure, 2018-11, Vol.11 (11), p.e005267-e005267

Ort / Verlag

United States

Erscheinungsjahr

2018

Quelle

EZB Electronic Journals Library

Beschreibungen/Notizen

• Gastrointestinal bleeding (GIB) is a leading cause of morbidity during continuous-flow left ventricular assist device (CF-LVAD) support. GIB risk assessment could have important implications for candidate selection, informed consent, and postimplant therapeutic strategies. The aim of the study is to derive and validate a predictive model of GIB in CF-LVAD patients. CF-LVAD recipients at the Utah Transplantation Affiliated Hospitals program between 2004 and 2017 were included. GIB associated with a decrease in hemoglobin ≥2 g/dL was the primary end point. A weighted score comprising preimplant variables independently associated with GIB was derived and internally validated. A total of 351 patients (median age, 59 years; 82% male) were included. After a median of 196 days, GIB occurred in 120 (34%) patients. Independent predictors of GIB included age >54 years, history of previous bleeding, coronary artery disease, chronic kidney disease, severe right ventricular dysfunction, mean pulmonary artery pressure <18 mm Hg, and fasting glucose >107 mg/dL. A weighted score termed Utah bleeding risk score, effectively stratified patients based on their probability of GIB: low (0-1 points) 4.8%, intermediate (2-4) 39.8%, and high risk (5-9) 83.8%. Discrimination was good in the development sample (c-index: 0.83) and after internal bootstrap validation (c-index: 0.74). The novel Utah bleeding risk score is a simple tool that can provide personalized GIB risk estimates in CF-LVAD patients. This scoring system may assist clinicians and investigators in designing tailored risk-based strategies aimed at reducing the burden posed by GIB in the individual CF-LVAD patient and healthcare systems.