Nakaji So, Okawa Yoshihiro, Nakamura Kenji, Itonaga Masahiro, Inase Masami, Sugiyama Harutoshi, Suzuki Rei, Yamauchi Kenji, Matsui Hiroki, Hirata Nobuto, Saito Junko, Ishii Naoki, Tsuyuguchi Toshio, Kato Hironari, Kitano Masayuki, Kato Naoya, Ohira Hiromasa, Okada Hiroyuki, Torimura Takuji, Maguchi Hiroyuki
Department of Gastroenterology Kameda Medical Center Chiba Japan.
Department of Gastroenterology Chikamori Hospital Kochi Japan.
JGH Open. 2020 May 17;4(5):915-922. doi: 10.1002/jgh3.12363. eCollection 2020 Oct.
Although hemodialysis (HD) is a strong risk factor for postendoscopic sphincterotomy (ES) bleeding, additional risk factors in HD patients remain unclear. There is no model for predicting post-ES bleeding risk in HD patients. Therefore, we conducted a retrospective multicenter study to reveal these risk factors and develop a predictive model of post-ES bleeding in HD patients.
We retrospectively reviewed the medical records of HD patients who underwent ES at eight hospitals between January 2006 and December 2016, with post-ES bleeding as the main outcome measure. Univariate analyses were performed to extract possible risk factors for post-ES bleeding. Factors that were clinically important and statistically significant in our univariate analyses were then included in our logistic regression analysis for the development of a multivariate predictive model of post-ES bleeding. This predictive model was visualized using a predictive nomogram.
Post-ES bleeding occurred in 20 (16.3%) of 123 HD patients. Based on clinically important factors and the results of our univariate analyses, platelet count, prothrombin time (international normalized ratio), and HD duration were included in our predictive model of post-ES bleeding. Receiver operating characteristic analysis found that this model had an area under the curve of 0.715 (95% confidence interval, 0.609-0.822). We developed a predictive nomogram based on these results.
We demonstrated that post-ES bleeding is more common in HD patients than in the general population and succeeded in constructing a predictive model that can effectively identify HD patients at risk of post-ES bleeding.
尽管血液透析（HD）是内镜下括约肌切开术（ES）后出血的一个重要危险因素，但HD患者的其他危险因素仍不明确。目前尚无预测HD患者ES后出血风险的模型。因此，我们进行了一项回顾性多中心研究，以揭示这些危险因素，并建立HD患者ES后出血的预测模型。
我们回顾性分析了2006年1月至2016年12月期间在八家医院接受ES的HD患者的病历，以ES后出血作为主要观察指标。进行单因素分析以提取ES后出血的可能危险因素。然后将在单因素分析中具有临床重要性和统计学意义的因素纳入逻辑回归分析，以建立ES后出血的多因素预测模型。使用预测列线图对该预测模型进行可视化。
123例HD患者中有20例（16.3%）发生了ES后出血。基于临床重要因素和单因素分析结果，血小板计数、凝血酶原时间（国际标准化比值）和HD持续时间被纳入ES后出血的预测模型。受试者工作特征分析发现，该模型的曲线下面积为0.715（95%置信区间，0.609 - 0.822）。我们根据这些结果开发了一个预测列线图。
我们证明了ES后出血在HD患者中比在普通人群中更常见，并成功构建了一个能够有效识别有ES后出血风险的HD患者的预测模型。
