Skip to main content
Top
Published in: European Journal of Medical Research 1/2023

Open Access 01-12-2023 | Gastrointestinal Bleeding | Research

Construction of a prediction model for rebleeding in patients with acute upper gastrointestinal bleeding

Authors: Yangping Zhuang, Shaohuai Xia, Junwei Chen, Jun Ke, Shirong Lin, Qingming Lin, Xiahong Tang, Hanlin Huang, Nan Zheng, Yi Wang, Feng Chen

Published in: European Journal of Medical Research | Issue 1/2023

Login to get access

Abstract

Background

The incidence of rebleeding in patients with upper gastrointestinal bleeding (UGIB) remains despite advances in intervention approaches. Therefore, early prediction of the risk of rebleeding could help to greatly reduce the mortality rate in these patients. We aim to develop and validate a new prediction model to predict the probability of rebleeding in patients with AUGIB.

Methods

A total of 1170 AUGIB patients who completed the procedure of emergency gastroscopy within 48 h of admission were included. Logistic regression analyses were performed to construct a new prediction model. A receiver operating characteristic curve, a line graph, and a calibration and decision curve were used to assess the predictive performance of our new prediction model and compare its performance with that of the AIMS65 scoring system to determine the predictive value of our prediction model.

Results

A new prediction model was constructed based on Lactic acid (LAC), neutrophil percentage (NEUTP), platelet (PLT), albumin (ALB), and D-DIMER. The AUC values and their 95% confidence interval (CI) for the new prediction model and the AIMS65 score were 0.746 and 0.619, respectively, and 0.697–0.795 and 0.567–0.670, respectively. In the training group, the C index values based on the prediction model and the AIMS65 scoring system were 0.720 and 0.610, respectively. In the validation group, the C index values based on the prediction model and the AIMS65 scoring system were 0.828 and 0.667, respectively. The decision and calibration curve analysis also showed that the prediction model was superior to the AIMS65 scoring system in terms of accuracy of prediction, consistency, and net clinical benefit.

Conclusion

The prediction model can predict the probability of rebleeding in AUGIB patients after endoscopic hemostasis therapy.
Literature
1.
go back to reference Czernichow P, Hochain P, Nousbaum JB, Raymond JM, Rudelli A, Dupas JL, Amouretti M, Gouerou H, Capron MH, Herman H, et al. Epidemiology and course of acute upper gastro-intestinal haemorrhage in four French geographical areas. Eur J Gastroenterol Hepatol. 2000;12(2):175–81.CrossRefPubMed Czernichow P, Hochain P, Nousbaum JB, Raymond JM, Rudelli A, Dupas JL, Amouretti M, Gouerou H, Capron MH, Herman H, et al. Epidemiology and course of acute upper gastro-intestinal haemorrhage in four French geographical areas. Eur J Gastroenterol Hepatol. 2000;12(2):175–81.CrossRefPubMed
2.
go back to reference Rockall TA, Logan RF, Devlin HB, Northfield TC. Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom. Steering Committee and members of the National Audit of Acute Upper Gastrointestinal Haemorrhage. BMJ. 1995;311(6999):222–6.CrossRefPubMedPubMedCentral Rockall TA, Logan RF, Devlin HB, Northfield TC. Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom. Steering Committee and members of the National Audit of Acute Upper Gastrointestinal Haemorrhage. BMJ. 1995;311(6999):222–6.CrossRefPubMedPubMedCentral
3.
go back to reference Longstreth GF. Epidemiology of hospitalization for acute upper gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol. 1995;90(2):206–10.PubMed Longstreth GF. Epidemiology of hospitalization for acute upper gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol. 1995;90(2):206–10.PubMed
5.
go back to reference Gilbert DA. Epidemiology of upper gastrointestinal bleeding. Gastrointest Endosc. 1990;36(5 Suppl):S8-13.PubMed Gilbert DA. Epidemiology of upper gastrointestinal bleeding. Gastrointest Endosc. 1990;36(5 Suppl):S8-13.PubMed
6.
go back to reference Lecleire S, Di Fiore F, Merle V, Herve S, Duhamel C, Rudelli A, Nousbaum JB, Amouretti M, Dupas JL, Gouerou H, et al. Acute upper gastrointestinal bleeding in patients with liver cirrhosis and in noncirrhotic patients: epidemiology and predictive factors of mortality in a prospective multicenter population-based study. J Clin Gastroenterol. 2005;39(4):321–7.CrossRefPubMed Lecleire S, Di Fiore F, Merle V, Herve S, Duhamel C, Rudelli A, Nousbaum JB, Amouretti M, Dupas JL, Gouerou H, et al. Acute upper gastrointestinal bleeding in patients with liver cirrhosis and in noncirrhotic patients: epidemiology and predictive factors of mortality in a prospective multicenter population-based study. J Clin Gastroenterol. 2005;39(4):321–7.CrossRefPubMed
7.
go back to reference Wang CY, Qin J, Wang J, Sun CY, Cao T, Zhu DD. Rockall score in predicting outcomes of elderly patients with acute upper gastrointestinal bleeding. World J Gastroenterol. 2013;19(22):3466–72.CrossRefPubMedPubMedCentral Wang CY, Qin J, Wang J, Sun CY, Cao T, Zhu DD. Rockall score in predicting outcomes of elderly patients with acute upper gastrointestinal bleeding. World J Gastroenterol. 2013;19(22):3466–72.CrossRefPubMedPubMedCentral
8.
go back to reference Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet. 2000;356(9238):1318–21.CrossRefPubMed Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet. 2000;356(9238):1318–21.CrossRefPubMed
9.
go back to reference Saltzman JR, Tabak YP, Hyett BH, Sun X, Travis AC, Johannes RS. A simple risk score accurately predicts in-hospital mortality, length of stay, and cost in acute upper GI bleeding. Gastrointest Endosc. 2011;74(6):1215–24.CrossRefPubMed Saltzman JR, Tabak YP, Hyett BH, Sun X, Travis AC, Johannes RS. A simple risk score accurately predicts in-hospital mortality, length of stay, and cost in acute upper GI bleeding. Gastrointest Endosc. 2011;74(6):1215–24.CrossRefPubMed
10.
go back to reference Tatliparmak AC, Dikme O, Dikme O, Topacoglu H. Cancer, platelet distribution width, and total protein levels as predictors of rebleeding in upper gastrointestinal bleeding. PeerJ. 2022;10:e14061.CrossRefPubMedPubMedCentral Tatliparmak AC, Dikme O, Dikme O, Topacoglu H. Cancer, platelet distribution width, and total protein levels as predictors of rebleeding in upper gastrointestinal bleeding. PeerJ. 2022;10:e14061.CrossRefPubMedPubMedCentral
11.
go back to reference Dunne PDJ, Laursen SB, Laine L, Dalton HR, Ngu JH, Schultz M, Rahman A, Anderloni A, Murray IA, Stanley AJ. Previous use of antithrombotic agents reduces mortality and length of hospital stay in patients with high-risk upper gastrointestinal bleeding. Clin Gastroenterol Hepatol. 2019;17(3):440–7.CrossRefPubMed Dunne PDJ, Laursen SB, Laine L, Dalton HR, Ngu JH, Schultz M, Rahman A, Anderloni A, Murray IA, Stanley AJ. Previous use of antithrombotic agents reduces mortality and length of hospital stay in patients with high-risk upper gastrointestinal bleeding. Clin Gastroenterol Hepatol. 2019;17(3):440–7.CrossRefPubMed
12.
go back to reference Souk KM, Tamim HM, Abu Daya HA, Rockey DC, Barada KA. Aspirin use for primary prophylaxis: adverse outcomes in non-variceal upper gastrointestinal bleeding. World J Gastrointest Surg. 2016;8(7):501–7.CrossRefPubMedPubMedCentral Souk KM, Tamim HM, Abu Daya HA, Rockey DC, Barada KA. Aspirin use for primary prophylaxis: adverse outcomes in non-variceal upper gastrointestinal bleeding. World J Gastrointest Surg. 2016;8(7):501–7.CrossRefPubMedPubMedCentral
13.
go back to reference Kim JS, Kim BW, Park SM, Shim KN, Jeon SW, Kim SW, Lee YC, Moon HS, Lee SH, Jung WT, et al. Factors associated with rebleeding in patients with peptic ulcer bleeding: analysis of the Korean peptic ulcer bleeding (K-PUB) study. Gut Liver. 2018;12(3):271–7.CrossRefPubMedPubMedCentral Kim JS, Kim BW, Park SM, Shim KN, Jeon SW, Kim SW, Lee YC, Moon HS, Lee SH, Jung WT, et al. Factors associated with rebleeding in patients with peptic ulcer bleeding: analysis of the Korean peptic ulcer bleeding (K-PUB) study. Gut Liver. 2018;12(3):271–7.CrossRefPubMedPubMedCentral
14.
go back to reference Fattah SA, El-Hamshary NK, Kilany YF, Salem MN, Ismael SA, Mostafa Bel D, El-Dessouky YM. Prognostic and predictive values of MELD score, platelet count and pre-albumin in patients with compensated and decompensated liver cirrhosis with acute variceal bleeding. J Egypt Soc Parasitol. 2012;42(2):443–52.CrossRefPubMed Fattah SA, El-Hamshary NK, Kilany YF, Salem MN, Ismael SA, Mostafa Bel D, El-Dessouky YM. Prognostic and predictive values of MELD score, platelet count and pre-albumin in patients with compensated and decompensated liver cirrhosis with acute variceal bleeding. J Egypt Soc Parasitol. 2012;42(2):443–52.CrossRefPubMed
15.
go back to reference Garcia-Iglesias P, Villoria A, Suarez D, Brullet E, Gallach M, Feu F, Gisbert JP, Barkun A, Calvet X. Meta-analysis: predictors of rebleeding after endoscopic treatment for bleeding peptic ulcer. Aliment Pharmacol Ther. 2011;34(8):888–900.CrossRefPubMed Garcia-Iglesias P, Villoria A, Suarez D, Brullet E, Gallach M, Feu F, Gisbert JP, Barkun A, Calvet X. Meta-analysis: predictors of rebleeding after endoscopic treatment for bleeding peptic ulcer. Aliment Pharmacol Ther. 2011;34(8):888–900.CrossRefPubMed
16.
go back to reference Lee SH, Min YW, Bae J, Lee H, Min BH, Lee JH, Rhee PL, Kim JJ. Lactate parameters predict clinical outcomes in patients with nonvariceal upper gastrointestinal bleeding. J Korean Med Sci. 2017;32(11):1820–7.CrossRefPubMedPubMedCentral Lee SH, Min YW, Bae J, Lee H, Min BH, Lee JH, Rhee PL, Kim JJ. Lactate parameters predict clinical outcomes in patients with nonvariceal upper gastrointestinal bleeding. J Korean Med Sci. 2017;32(11):1820–7.CrossRefPubMedPubMedCentral
17.
go back to reference El-Kersh K, Chaddha U, Sinha RS, Saad M, Guardiola J, Cavallazzi R. Predictive role of admission lactate level in critically Ill patients with acute upper gastrointestinal bleeding. J Emerg Med. 2015;49(3):318–25.CrossRefPubMed El-Kersh K, Chaddha U, Sinha RS, Saad M, Guardiola J, Cavallazzi R. Predictive role of admission lactate level in critically Ill patients with acute upper gastrointestinal bleeding. J Emerg Med. 2015;49(3):318–25.CrossRefPubMed
18.
go back to reference Ko BS, Kim WY, Ryoo SM, Ahn S, Sohn CH, Seo DW, Lee YS, Lim KS, Jung HY. Predicting the occurrence of hypotension in stable patients with nonvariceal upper gastrointestinal bleeding: point-of-care lactate testing. Crit Care Med. 2015;43(11):2409–15.CrossRefPubMed Ko BS, Kim WY, Ryoo SM, Ahn S, Sohn CH, Seo DW, Lee YS, Lim KS, Jung HY. Predicting the occurrence of hypotension in stable patients with nonvariceal upper gastrointestinal bleeding: point-of-care lactate testing. Crit Care Med. 2015;43(11):2409–15.CrossRefPubMed
19.
go back to reference Kwon YH. Lactate Parameters predict clinical outcomes in patients with nonvariceal upper gastrointestinal bleeding. J Korean Med Sci. 2017;32(11):1731.CrossRefPubMedPubMedCentral Kwon YH. Lactate Parameters predict clinical outcomes in patients with nonvariceal upper gastrointestinal bleeding. J Korean Med Sci. 2017;32(11):1731.CrossRefPubMedPubMedCentral
20.
go back to reference Bonnet N, Paul J, Helleputte T, Veyckemans F, Pirotte T, Pregardien C, Eeckhoudt S, Hermans C, Detaille T, Clapuyt P, et al. Novel insights into the assessment of risk of upper gastrointestinal bleeding in decompensated cirrhotic children. Pediatr Transplant. 2019;23(4):e13390.CrossRefPubMed Bonnet N, Paul J, Helleputte T, Veyckemans F, Pirotte T, Pregardien C, Eeckhoudt S, Hermans C, Detaille T, Clapuyt P, et al. Novel insights into the assessment of risk of upper gastrointestinal bleeding in decompensated cirrhotic children. Pediatr Transplant. 2019;23(4):e13390.CrossRefPubMed
21.
go back to reference Vreeburg EM, Levi M, Rauws EA, Deventer SJ, Snel P, Bartelsman JW, Ten Cate JW, Tytgat GN. Enhanced mucosal fibrinolytic activity in gastroduodenal ulcer haemorrhage and the beneficial effect of acid suppression. Aliment Pharmacol Ther. 2001;15(5):639–46.CrossRefPubMed Vreeburg EM, Levi M, Rauws EA, Deventer SJ, Snel P, Bartelsman JW, Ten Cate JW, Tytgat GN. Enhanced mucosal fibrinolytic activity in gastroduodenal ulcer haemorrhage and the beneficial effect of acid suppression. Aliment Pharmacol Ther. 2001;15(5):639–46.CrossRefPubMed
22.
go back to reference Violl F, Basili S, Ferro D, Quintarelli C, Alessandril C, Cordova C. Association between high values of D-dimer and tissue-plasminogen activator activity and first gastrointestinal bleeding in cirrhotic patients. CALC Group. Thromb Haemost. 1996;76(2):177–83.CrossRefPubMed Violl F, Basili S, Ferro D, Quintarelli C, Alessandril C, Cordova C. Association between high values of D-dimer and tissue-plasminogen activator activity and first gastrointestinal bleeding in cirrhotic patients. CALC Group. Thromb Haemost. 1996;76(2):177–83.CrossRefPubMed
23.
go back to reference Gutierrez A, Sanchez-Paya J, Marco P, Perez-Mateo M. Prognostic value of fibrinolytic tests for hospital outcome in patients with acute upper gastrointestinal hemorrhage. J Clin Gastroenterol. 2001;32(4):315–8.CrossRefPubMed Gutierrez A, Sanchez-Paya J, Marco P, Perez-Mateo M. Prognostic value of fibrinolytic tests for hospital outcome in patients with acute upper gastrointestinal hemorrhage. J Clin Gastroenterol. 2001;32(4):315–8.CrossRefPubMed
24.
go back to reference Yue W, Liu Y, Jiang W, Huang J, Liu J. Prealbumin and D-dimer as prognostic indicators for rebleeding in patients with nonvariceal upper gastrointestinal bleeding. Dig Dis Sci. 2021;66(6):1949–56.CrossRefPubMed Yue W, Liu Y, Jiang W, Huang J, Liu J. Prealbumin and D-dimer as prognostic indicators for rebleeding in patients with nonvariceal upper gastrointestinal bleeding. Dig Dis Sci. 2021;66(6):1949–56.CrossRefPubMed
Metadata
Title
Construction of a prediction model for rebleeding in patients with acute upper gastrointestinal bleeding
Authors
Yangping Zhuang
Shaohuai Xia
Junwei Chen
Jun Ke
Shirong Lin
Qingming Lin
Xiahong Tang
Hanlin Huang
Nan Zheng
Yi Wang
Feng Chen
Publication date
01-12-2023
Publisher
BioMed Central
Published in
European Journal of Medical Research / Issue 1/2023
Electronic ISSN: 2047-783X
DOI
https://doi.org/10.1186/s40001-023-01349-3

Other articles of this Issue 1/2023

European Journal of Medical Research 1/2023 Go to the issue