Boortalary Tina, Erwin Ryan, Dong Michael, Shinn Brianna, Infantolino Anthony, Tofani Christina
Department of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, 132 S. 10th St. Main Building, Suite 480, Philadelphia, PA, 19107, USA.
Dig Dis Sci. 2023 Jan;68(1):187-192. doi: 10.1007/s10620-022-07527-3. Epub 2022 May 11.
Patients with obscure gastrointestinal bleeding undergo small bowel capsule endoscopy (SBCE), but often return for recurrent bleeding or anemia. The RHEMITT score evaluates patients based on 7 variables (heart failure, chronic kidney disease, Saurin P1/P2 lesions, major bleeding, incomplete SBCE, smoking status, and endoscopic treatment) and seeks to predict the risk of rebleeding.
This study aims to perform an external validation of the RHEMITT score in the United States.
SBCEs performed to evaluate anemia or GI bleeding from a tertiary-care center's PillCam database between 1/22/2018 and 7/21/2020 were reviewed. Variables based on the RHEMITT score were collected. The primary outcome was rebleeding, defined as (1) melena or hematochezia or (2) hemoglobin drop of 2 g/dL. Patient were categorized into low, intermediate, and high-risk categories based on RHEMITT score. The accuracy of the RHEMITT score for predicting rebleeding was assessed.
A total of 361 SBCEs were included in the study. Age, indication for SBCE, endoscopic treatment, antiplatelet use, cirrhosis, heart failure, chronic kidney disease, and major bleeding were significantly associated with risk of rebleed (p < 0.05). Each increasing risk category for the RHEMITT score predicted increased probability of this study's primary outcome, rebleeding (p < 0.001). There was a significant association between RHEMITT risk category and rebleeding-free survival (log-rank p < 0.001). An area under the receiver operating characteristic curve for the RHEMITT score was 0.790 (p < 0.001).
Our findings validate the RHEMITT score and confirm acceptable performance for predicting rebleeding at a tertiary referral center in the United States.
不明原因胃肠道出血患者接受小肠胶囊内镜检查（SBCE），但常因反复出血或贫血而复诊。RHEMITT评分基于7个变量（心力衰竭、慢性肾脏病、索林P1/P2病变、大出血、不完全SBCE、吸烟状况和内镜治疗）对患者进行评估，并试图预测再出血风险。
本研究旨在在美国对RHEMITT评分进行外部验证。
回顾了2018年1月22日至2020年7月21日期间在一家三级医疗中心的PillCam数据库中为评估贫血或胃肠道出血而进行的SBCE。收集基于RHEMITT评分的变量。主要结局为再出血，定义为：（1）黑便或便血；或（2）血红蛋白下降2g/dL。根据RHEMITT评分将患者分为低、中、高风险类别。评估RHEMITT评分预测再出血的准确性。
本研究共纳入361例SBCE。年龄、SBCE指征、内镜治疗、抗血小板药物使用、肝硬化、心力衰竭、慢性肾脏病和大出血与再出血风险显著相关（p<0.05）。RHEMITT评分的每个风险类别增加均预示着本研究主要结局再出血的概率增加（p<0.001）。RHEMITT风险类别与无再出血生存期之间存在显著关联（对数秩检验p<0.001）。RHEMITT评分的受试者工作特征曲线下面积为0.790（p<0.001）。
我们的研究结果验证了RHEMITT评分，并证实其在美国一家三级转诊中心预测再出血的性能可接受。
