Background: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.Methods and Results: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).Conclusions: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.

中文翻译：

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预测左心室辅助装置支持期间胃肠道出血的新模型

背景：胃肠道出血（GIB）是连续流左心室辅助装置（CF-LVAD）支持期间发病的主要原因。GIB风险评估可能对候选人的选择，知情同意书和植入后治疗策略具有重要意义。该研究的目的是推导和验证CF-LVAD患者的GIB预测模型。方法和结果：包括2004年至2017年犹他州移植附属医院计划的CF-LVAD接受者。主要研究终点是与血红蛋白≥2g / dL降低相关的GIB。得出包括与GIB独立相关的植入前变量的加权评分，并在内部进行验证。总共纳入351例患者（中位年龄59岁；男性占82％）。中位196天后，GIB发生在120名（34％）患者中。GIB的独立预测因素包括年龄> 54岁，既往有出血史，冠状动脉疾病，慢性肾脏疾病，严重的右心室功能障碍，平均肺动脉压<18 mm Hg和空腹血糖> 107 mg / dL。加权得分称为犹他州出血风险得分，根据其GIB概率对患者进行有效分层：低（0-1分）4.8％，中（2-4）39.8％，高危（5-9）83.8％。在开发样本中（c指数：0.83）和在内部引导程序验证后（c指数：0.74），歧视是很好的。结论：新的犹他州出血风险评分是一种简单的工具，可以在CF-LVAD中提供个性化的GIB风险评估耐心。