Prediction of GIB Using R2 CHA2DS2 VASc Risk Score

Abstract

Purpose Continuous flow left ventricular assist device (CF-LVAD) support has been associated with high rates of gastrointestinal bleeding (GIB). We analyzed the ability of the R2CHA2DS2 VASc scoring system to predict GIB in patients on CF-LVAD support. Methods We performed a retrospective review of 526 patients who underwent implantation of CF-LVADs from November 2003 through March 2016 at our center. The R2 CHA2DS2 VASc score was calculated preoperatively for each patient, and logistic regression analysis and receiver operating characteristic (ROC) curve analysis were performed to determine whether this risk score predicted GIB. Additional analyses were performed using the R2 CHA2DS2 VASc score to identify etiologies and locations of GIB. Results R2CHA2DS2 VASc score was calculated for 519 patients; 7 patients were excluded due to incomplete data. Average score was 5.1±1.4 (Figure). A total of 218 GIB event occurred in 140 patients; 48 experienced a recurrent GIB. Median time to GIB event was 78 days (interquartile range = 36.5-2298.75 days). The most common etiology was atriovenous malformations (72 events in 50 patients). The R2 CHA2DS2 VASc score successfully predicted GIB (Odds ratio [OR]=1.4, p=0.001) and was especially significant for GIB from ulcers (OR=1.4, p=0.002) and AVMs (OR=1.5, p=0.001) in the stomach (OR=1.3, p=0.004) and duodenum (OR=1.5, p=0.02; Table). ROC curve analysis resulted in an area under the curve of 0.63. Conclusion The R2 CHA2DS2 VASc risk score accurately predicted GIB events in CF-LVAD recipients from AVMs and ulcers in the stomach and duodenum. This may be useful in the selection and management of patients being considered for LVAD implantation.