HAS-BLED Score for Prediction of Bleeding and Mortality After Transcatheter Aortic Valve Replacement

ABSTRACT Introduction: Bleeding after transcatheter aortic valve replacement (TAVR) is associated with increased mortality. The predictive value of the HAS-BLED score in TAVR patients is still to be evaluated. We assessed the value of the HAS-BLED score to predict in-hospital bleeding and mortality after TAVR and the impact of diferent renal impairment definitions on the predictive value of the score system. Methods: We retrospectively included 574 patients who underwent TAVR at a single center. Study outcomes were 30-day mortality and the composite endpoint of major and life-threatening bleeding as defined by The Valve Academic Research Consortium-2. The predictive value of the HAS-BLED score was calculated and compared to a modified model. The performance of the score was compared using two definitions of renal impairment. Model discrimination was tested using C-statistic and the Net Reclassification Index. Results: Bleeding occurred in 78 patients (13.59%). HAS-BLED category 3 was a significant predictor of bleeding (OR: 1.99 ]1.18- 3.37], C-index: 0.56, P=0.01). C-index increased to 0.64 after adding body surface area and extracardiac arteriopathy to the model. The Net Reclassification Index showed an increase in the predic tive value of the model by 11.4% (P=0.002). The C-index increased to 0.61 using renal impairment definition based on creatinine clearance. Operative mortality was significantly associated with the HAS-BLED score (OR: 7.54 [95% CI: 2.73- 20.82], C-index: 0.73, P<0.001). Conclusion: The HAS-BLED score could be a good predictor of in-hospital mortality after TAVR. Its predictive value for bleeding was poor but improved by adding procedure-specific factors and using creatinine clearance to define renal impairment.

摘要
引言：经导管主动脉瓣置换术（Transcatheter Aortic Valve Replacement, TAVR）术后出血与死亡率升高密切相关。目前HAS-BLED评分在TAVR患者中的预测价值仍有待明确。本研究旨在评估HAS-BLED评分对TAVR术后院内出血及术后死亡率的预测价值，同时探讨不同肾功能损害定义对该评分系统预测效能的影响。

方法：本研究回顾性纳入了单中心接受TAVR治疗的574例患者。研究终点包括30天死亡率，以及按照瓣膜学术研究联盟-2（Valve Academic Research Consortium-2）定义的大出血及威胁生命的出血复合终点。本研究计算了HAS-BLED评分的预测价值，并与改良模型进行对比；同时采用两种肾功能损害定义，对该评分的预测性能进行比较。模型的区分度采用C统计量（C-statistic）与净重新分类指数（Net Reclassification Index）进行检验。

结果：共78例患者（13.59%）发生术后出血。HAS-BLED评分3级是出血事件的显著预测因子（比值比[OR]：1.99，95%置信区间[CI]：1.18~3.37，C指数：0.56，P=0.01）。在模型中加入体表面积（body surface area）与心外动脉病（extracardiac arteriopathy）后，C指数升至0.64。净重新分类指数显示，模型的预测价值提升了11.4%（P=0.002）。采用基于肌酐清除率（creatinine clearance）的肾功能损害定义时，C指数升至0.61。手术死亡率与HAS-BLED评分显著相关（OR：7.54，95%CI：2.73~20.82，C指数：0.73，P<0.001）。

结论：HAS-BLED评分可较好预测TAVR术后院内死亡率。其针对出血事件的预测价值欠佳，但通过加入手术特异性因素以及采用肌酐清除率定义肾功能损害，可有效提升其预测效能。