Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi Province, China.
First School of Clinical Medicine, Nanchang University, Nanchang, 330006, Jiangxi, China.
BMC Gastroenterol. 2022 Feb 14;22(1):64. doi: 10.1186/s12876-022-02145-9.
Peptic ulcer bleeding remains a typical medical emergency with significant morbidity and mortality. Peptic ulcer rebleeding often occurs within three days after emergent endoscopic hemostasis. Our study aims to develop a nomogram to predict rebleeding within three days after emergent endoscopic hemostasis for high-risk peptic ulcer bleeding.
We retrospectively reviewed the data of 386 patients with bleeding ulcers and high-risk stigmata who underwent emergent endoscopic hemostasis between March 2014 and October 2018. The least absolute shrinkage and selection operator method was used to identify predictors. The model was displayed as a nomogram. Internal validation was carried out using bootstrapping. The model was evaluated using the calibration plot, decision-curve analyses, and clinical impact curve.
Overall, 386 patients meeting the inclusion criteria were enrolled, with 48 patients developed rebleeding within three days after initial endoscopic hemostasis. Predictors contained in the nomogram included albumin, prothrombin time, shock, haematemesis/melena and Forrest classification. The model showed good discrimination and good calibration with a C-index of 0.854 (C-index: 0.830 via bootstrapping validation). Decision-curve analyses and clinical impact curve also demonstrated that it was clinically valuable.
This study presents a nomogram that incorporates clinical, laboratory, and endoscopic features, effectively predicting rebleeding within three days after emergent endoscopic hemostasis and identifying high-risk rebleeding patients with peptic ulcer bleeding. Trial registration This clinical trial has been registered in the ClinicalTrials.gov (ID: NCT04895904) approved by the International Committee of Medical Journal Editors (ICMJE).
消化性溃疡出血仍是一种具有较高发病率和死亡率的典型急症。在急诊内镜止血后 3 天内，消化性溃疡常再次出血。本研究旨在为高危消化性溃疡出血患者开发一种预测内镜止血后 3 天内再出血的列线图。
我们回顾性分析了 2014 年 3 月至 2018 年 10 月期间接受急诊内镜止血的 386 例出血性溃疡和高危征象患者的数据。使用最小绝对收缩和选择算子法识别预测因子。模型以列线图的形式呈现。内部验证采用 bootstrap 法。通过校准图、决策曲线分析和临床影响曲线评估模型。
共纳入 386 例符合纳入标准的患者，其中 48 例患者在初始内镜止血后 3 天内再次出血。列线图中的预测因子包括白蛋白、凝血酶原时间、休克、呕血/黑便和 Forrest 分级。该模型具有良好的区分度和校准度，C 指数为 0.854（通过 bootstrap 验证的 C 指数为 0.830）。决策曲线分析和临床影响曲线也表明该模型具有临床价值。
本研究提出了一种包含临床、实验室和内镜特征的列线图，能够有效预测急诊内镜止血后 3 天内再出血，并识别高危消化性溃疡出血再出血患者。
本临床试验已在临床试验.gov（ID：NCT04895904）注册，经国际医学期刊编辑委员会（ICMJE）批准。
