Feng Kaijun, Song Qiuming, Xue Ming
Department of Critical Care Medicine, The Third People's Hospital of Hefei (Hefei Third Clinical College of Anhui Medical University) Hefei 230022, Anhui, China.
Am J Transl Res. 2025 Jul 15;17(7):5011-5024. doi: 10.62347/EOOS8728. eCollection 2025.
To identify risk factors for gastrointestinal bleeding (GIB) in patients with ischemic stroke and to develop a clinically applicable predictive model.
A retrospective case-control study was conducted on ischemic stroke patients admitted to The Third People's Hospital of Hefei. The training cohort included 96 patients who developed GIB between January 2021 and January 2023 (as cases) and 104 age-matched stroke patients who did not develop GIB (as controls). Risk factors were identified using univariate and multivariate logistic regression analyses. A separate validation cohort (40 GIB-cases and 48 controls) admitted between February 2023 and June 2024 was used to assess model's performance.
Univariate analysis identified several significant risk factors, including a history of gastrointestinal diseases, use of anticoagulants or antiplatelet drugs, a Glasgow Coma Scale (GCS) score ≤ 8, and prolonged prothrombin time (PT). Multivariate analysis showed that all four factors were independent predictors: history of stomach or intestinal disease (odds ratio [OR]=3.31, 95% confidence interval [CI]: 1.04-10.49), use of anticoagulants or antiplatelet drugs (OR=4.09, 95% CI: 1.68-9.99), GCS score ≤8 (OR=4.75, 95% CI: 1.18-19.16), and prolonged PT (OR=1.15, 95% CI: 1.04-1.28). A predictive nomogram based on these four factors demonstrated good performance, with an area under the curve (AUC) of 0.73 in the training cohort and 0.79 in the validation cohort. The calibration curve indicated that the nomogram's predictions matched closely with real outcomes. The decision curve analysis (DCA) also showed that the model provided evident clinical benefits.
Four independent risk factors for GIB in ischemic stroke patients were identified. The developed nomogram may assist clinicians in early risk assessment and inform treatment decisions.
确定缺血性脑卒中患者发生胃肠道出血（GIB）的危险因素，并建立一个临床适用的预测模型。
对合肥市第三人民医院收治的缺血性脑卒中患者进行回顾性病例对照研究。训练队列包括2021年1月至2023年1月期间发生GIB的96例患者（作为病例组）和104例年龄匹配的未发生GIB的脑卒中患者（作为对照组）。采用单因素和多因素逻辑回归分析确定危险因素。2023年2月至2024年6月期间收治的一个单独的验证队列（40例GIB病例和48例对照）用于评估模型的性能。
单因素分析确定了几个显著的危险因素，包括胃肠道疾病史、使用抗凝剂或抗血小板药物、格拉斯哥昏迷量表（GCS）评分≤8以及凝血酶原时间（PT）延长。多因素分析显示，所有这四个因素都是独立的预测因素：胃或肠道疾病史（比值比[OR]=3.31，95%置信区间[CI]：1.04-10.49）、使用抗凝剂或抗血小板药物（OR=4.09，95%CI：1.68-9.99）、GCS评分≤8（OR=4.75，95%CI：1.18-19.16）以及PT延长（OR=1.15，95%CI：1.04-1.28）。基于这四个因素的预测列线图表现良好，训练队列中的曲线下面积（AUC）为0.73，验证队列中的AUC为0.79。校准曲线表明列线图的预测与实际结果密切匹配。决策曲线分析（DCA）也表明该模型具有明显的临床益处。
确定了缺血性脑卒中患者发生GIB的四个独立危险因素。所建立的列线图可帮助临床医生进行早期风险评估并为治疗决策提供参考。
