Department of Gastroenterology, Hospital Senhora da Oliveira, Guimarães, Portugal,
Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal,
Dig Dis. 2020;38(4):299-309. doi: 10.1159/000504385. Epub 2019 Nov 19.
Small bowel capsule endoscopy (SBCE) is the gold standard for mid-gastrointestinal bleeding (MGIB). No score has been developed to predict the risk of small bowel rebleeding after SBCE.
Creating a predictive small bowel rebleeding risk score for MGIB, after initial SBCE.
Retrospective, single center study, including SBCEs for MGIB, from June 2006 to October 2016. The minimum follow-up was 12 months. Univariate analysis and a multivariable Cox regression model tested the association with rebleeding. Statistically significant variables were used to compute the score. The score's accuracy was tested through a receiver operating characteristic (ROC) curve. A classification tree identified risk groups. For internal validation, we performed a 5-fold cross validation.
We assessed 357 SBCEs for MGIB, of which 88 (24.6%) presented rebleeding during follow-up. Seven variables were used to compute a risk-predicting score - the RHEMITT score - namely, renal disease; heart failure; endoscopic capsule P1/P2 lesions; major bleeding; incomplete capsule; tobacco consumption; and endoscopic treatment. The score presented good accuracy toward the outcome (area under the curve ROC 0.842, 95% CI 0.757-0.927). We established 3 rebleeding risk groups: low (0-3 points); intermediate (4-10 points); and high (+11 points).
A new MGIB score, named RHEMITT, accurately anticipates the individual risk of small bowel rebleeding after initial SBCE.
小肠胶囊内镜（SBCE）是中消化道出血（MGIB）的金标准。尚未开发出用于预测 SBCE 后小肠再出血风险的评分。
为初始 SBCE 后 MGIB 建立预测小肠再出血风险的评分。
回顾性、单中心研究，纳入 2006 年 6 月至 2016 年 10 月间因 MGIB 而行 SBCE 的患者。最短随访时间为 12 个月。单因素分析和多变量 Cox 回归模型用于检验与再出血的相关性。使用有统计学意义的变量来计算评分。通过接收者操作特征（ROC）曲线来检验评分的准确性。分类树确定了风险组。为了内部验证，我们进行了 5 折交叉验证。
我们评估了 357 例因 MGIB 而行 SBCE 的患者，其中 88 例（24.6%）在随访期间出现再出血。有 7 个变量用于计算风险预测评分 - RHEMITT 评分，即肾脏疾病；心力衰竭；内镜胶囊 P1/P2 病变；大出血；胶囊未完全通过；吸烟；和内镜治疗。该评分对该结局具有良好的准确性（ROC 曲线下面积 0.842，95%CI 0.757-0.927）。我们建立了 3 个再出血风险组：低危（0-3 分）；中危（4-10 分）；高危（+11 分）。
一种新的 MGIB 评分，命名为 RHEMITT，可准确预测初始 SBCE 后小肠再出血的个体风险。
