Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
Dig Endosc. 2023 Sep;35(6):777-789. doi: 10.1111/den.14533. Epub 2023 Mar 28.
Stigmata of recent hemorrhage (SRH) directly indicate a need for endoscopic therapy in acute lower gastrointestinal bleeding (LGIB). Colonoscopy would be prioritized for patients with highly suspected SRH, but the predictors of colonic SRH remain unclear. We aimed to construct a predictive model for the efficient detection of SRH using a nationwide cohort.
We retrospectively analyzed 8360 patients admitted through hospital emergency departments for acute LGIB in the CODE BLUE-J Study (49 hospitals throughout Japan). All patients underwent inpatient colonoscopy. To develop an SRH predictive model, 4863 patients were analyzed. Baseline characteristics, colonoscopic factors (timing, preparation, and devices), and computed tomography (CT) extravasation were extensively assessed. The performance of the model was externally validated in 3497 patients.
Colonic SRH was detected in 28% of patients. A novel predictive model for detecting SRH (CS-NEED score: ColonoScopic factors, No abdominal pain, Elevated PT-INR, Extravasation on CT, and DOAC use) showed high performance (area under the receiver operating characteristic curve [AUC] 0.74 for derivation and 0.73 for external validation). This score was also highly predictive of active bleeding (AUC 0.73 for derivation and 0.76 for external validation). Patients with low (0-6), intermediate (7-8), and high (9-12) scores in the external validation cohort had SRH identification rates of 20%, 31%, and 64%, respectively (P < 0.001 for trend).
A novel predictive model for colonic SRH identification (CS-NEED score) can specify colonoscopies likely to achieve endoscopic therapy in acute LGIB. Using the model during initial management would contribute to finding and treating SRH efficiently.
近期出血征象（SRH）直接表明急性下消化道出血（LGIB）需要内镜治疗。对于高度怀疑有 SRH 的患者，将优先进行结肠镜检查，但结肠 SRH 的预测因素仍不清楚。我们旨在使用全国性队列构建一种用于有效检测 SRH 的预测模型。
我们回顾性分析了 CODE BLUE-J 研究（日本全国 49 家医院）中因急性 LGIB 住院的 8360 例患者。所有患者均接受住院结肠镜检查。为了建立 SRH 预测模型，分析了 4863 例患者。广泛评估了基线特征、结肠镜检查因素（时机、准备和设备）和计算机断层扫描（CT）外渗情况。在 3497 例患者中对模型的性能进行了外部验证。
28%的患者检测到结肠 SRH。一种用于检测 SRH 的新型预测模型（CS-NEED 评分：结肠镜因素、无腹痛、PT-INR 升高、CT 外渗和使用 DOAC）表现出较高的性能（推导的受试者工作特征曲线下面积 [AUC]为 0.74，外部验证的 AUC 为 0.73）。该评分对活动性出血也具有高度预测性（推导的 AUC 为 0.73，外部验证的 AUC 为 0.76）。在外部验证队列中，低（0-6）、中（7-8）和高（9-12）评分的患者的 SRH 检出率分别为 20%、31%和 64%（趋势 P<0.001）。
一种用于识别结肠 SRH 的新型预测模型（CS-NEED 评分）可以确定急性 LGIB 中可能进行内镜治疗的结肠镜检查。在初始管理中使用该模型将有助于有效地发现和治疗 SRH。
