Department of Gastroenterology, Christian Medical College and Hospital, Vellore, Tamil Nadu, 632004, India.
Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India.
Dig Dis Sci. 2018 Dec;63(12):3442-3447. doi: 10.1007/s10620-018-5245-7. Epub 2018 Aug 14.
The guidelines for performing endoscopy in dyspeptic patients based on clinical parameters alone have shown variable performance, and there is a need for better prediction tools.
We aimed to prospectively develop and validate a simple clinical-cum-laboratory test-based scoring model to identify dyspeptic patients with high risk of upper gastrointestinal malignancy (UGIM).
Adult patients with dyspeptic symptoms were prospectively recruited over 5 years. Clinical details including alarm features were recorded, and blood tests for hemoglobin and albumin were done before endoscopy. The presence of UGIM was the primary outcome. Risk factors for UGIM were assessed, and based on the OR of significant factors, a predictive scoring model was constructed. ROC curve was plotted to identify optimal cutoff score. The model was validated using bootstrapping technique.
The study included 2324 patients (41.9 ± 12.8 years; 33.4% females). UGIM was noted in 6.8% patients. The final model had following five positive predictors for UGIM-age > 40 years (OR 3.3, score 1); albumin ≤ 3.5 g% (OR 3.4, score 1); Hb ≤ 11 g% (OR 3.3, score 1); alarm features (OR 5.98, score 2); recent onset of symptoms (OR 8.7, score 3). ROC curve had an impressive AUC of 0.9 (0.88-0.93), and a score of 2 had 92.5% sensitivity in predicting UGIM. Validation by bootstrapping showed zero bias, which further strengthened our model.
This simple clinical-cum-laboratory test-based model performed very well in identifying dyspeptic patients at risk of UGIM. This can serve as a useful decision-making tool for referral for endoscopy.
基于临床参数进行内镜检查的消化不良患者指南显示出可变的性能，因此需要更好的预测工具。
我们旨在前瞻性地开发和验证一种基于简单临床和实验室测试的评分模型，以识别患有上消化道恶性肿瘤（UGIM）高风险的消化不良患者。
在 5 年内前瞻性招募了有消化不良症状的成年患者。记录了临床详细信息，包括报警特征，并在内镜检查前进行了血红蛋白和白蛋白的血液检查。上消化道恶性肿瘤的存在是主要结果。评估了 UGIM 的危险因素，并根据显著因素的 OR，构建了预测评分模型。绘制 ROC 曲线以确定最佳截断分数。使用自举技术验证该模型。
该研究纳入了 2324 名患者（41.9±12.8 岁；33.4%为女性）。UGIM 见于 6.8%的患者。最终模型有五个阳性预测因子用于 UGIM-age>40 岁（OR 3.3，得分为 1）；白蛋白≤3.5%（OR 3.4，得分为 1）；Hb≤11g%（OR 3.3，得分为 1）；报警特征（OR 5.98，得分为 2）；症状近期发作（OR 8.7，得分为 3）。ROC 曲线的 AUC 令人印象深刻，为 0.9（0.88-0.93），得分 2 时预测 UGIM 的敏感性为 92.5%。自举验证显示零偏差，这进一步加强了我们的模型。
这个基于简单临床和实验室测试的模型在识别有上消化道恶性肿瘤风险的消化不良患者方面表现非常出色。这可以作为内镜检查转诊的有用决策工具。
