Validation and modification of existing mortality prediction models for lower gastrointestinal bleeding: a retrospective study

Abstract Background Lower gastrointestinal bleeding (LGIB) often subsides without medical intervention; however, in some cases, the bleeding does not stop and the patient’s condition worsens. Therefore, predicting severe LGIB in advance can aid treatment. This study aimed to evaluate variables related to mortality from LGIB and propose a scoring system. Methods In this retrospective study, we reviewed the medical records of patients who visited the emergency room with hematochezia between January 2016 and December 2020. Through regression analysis of comorbidities, medications, vital signs, laboratory investigations, and duration of hospital stay, variables related to LGIB-related mortality were evaluated. A scoring system was developed and the appropriateness with an area under the receiver operating characteristics curve (AUROC) was evaluated and compared with other existing models. Results A total of 932 patients were hospitalized for LGIB. Variables associated with LGIB-related mortality were the presence of cancer, heart rate > 100 beats/min, blood urea nitrogen level ≥ 30 mg/dL, an international normalized ratio > 1.50, and albumin level ≤ 3.0 g/dL. The AUROCs of the models CNUH-4 and CNUH-5 were 0.890 (p < 0.001; cutoff, 2.5; 95% confidence interval, 0.0851–0.929) and 0.901 (p < 0.001; cutoff, 3.5; 95% confidence interval, 0.869–0.933), respectively. Conclusions The model developed for predicting the risk of LGIB-related mortality is simple and easy to apply clinically. The AUROC of the model was better than that of the existing models.

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Validation and modification of existing mortality prediction model for lower gastrointestinal bleeding: A retrospective study

10.21203/rs.3.rs-701789/v1 ◽

2021 ◽

Author(s):

Hyun Suk Lee ◽

Hee Seok Moon ◽

In Sun Kwon ◽

Hyun Yong Jeong ◽

Byung Seok Lee ◽

...

Keyword(s):

Retrospective Study ◽

Confidence Interval ◽

Gastrointestinal Bleeding ◽

Scoring System ◽

Vital Signs ◽

International Normalized Ratio ◽

Mortality Prediction ◽

Lower Gastrointestinal Bleeding ◽

Operating Characteristics ◽

Related Mortality

Abstract Background Lower gastrointestinal bleeding (LGIB) often subsides by itself; however, in some cases, the bleeding does not stop and the patient’s condition worsens. Therefore, if the occurrence of severe lower gastrointestinal bleeding can be predicted in advance, it can be helpful for treatment. This study aimed to evaluate variables related to mortality from LGIB and to propose a scoring system. Methods This retrospective study reviewed the medical records of patients who visited the emergency room with hematochezia between January 2016 and December 2020. Through regression analysis of vital signs, laboratory investigations, and hospital stay, variables related to LGIB-related mortality were evaluated. A scoring system was developed, and the appropriateness with an area under the receiver operating characteristics curve (AUROC) was evaluated and compared with other existing models. Results A total of 932 patients were hospitalized for LGIB. Variables associated with LGIB-related mortality were the presence of cancer, heart rate of > 100 beats/min, blood urea nitrogen level of ≥ 30 mg/dL, an international normalized ratio of > 1.50, and albumin level of ≤ 3.0 g/dL. The AUROCs of CNUH-4 and CNUH-5 were 0.890 (p < 0.001; cutoff, 2.5; 95% confidence interval, 0.0851 − 0.929) and 0.901 (p < 0.001; cutoff, 3.5; 95% confidence interval, 0.869 − 0.933), respectively. Conclusions The model developed for predicting the risk of LGIB-related mortality is simple and easy to apply clinically. The AUROC of the model was better than that of the existing models.

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Performance of the Surprise Question Compared to Prediction Models in Hemodialysis Patients: A Prospective Study

American Journal of Nephrology ◽

10.1159/000481920 ◽

2017 ◽

Vol 46 (5) ◽

pp. 390-396 ◽

Cited By ~ 4

Author(s):

Rakesh Malhotra ◽

Xia Tao ◽

Yuedong Wang ◽

Yuqi Chen ◽

Rebecca H. Apruzzese ◽

...

Keyword(s):

Linear Models ◽

Prediction Models ◽

Clinical Laboratory ◽

Mortality Prediction ◽

Operating Characteristics ◽

Dialysis Treatment ◽

Mortality Probability ◽

A Prospective Study ◽

Surprise Question

Background: The surprise question (SQ) (“Would you be surprised if this patient were still alive in 6 or 12 months?”) is used as a mortality prognostication tool in hemodialysis (HD) patients. We compared the performance of the SQ with that of prediction models (PMs) for 6- and 12-month mortality prediction. Methods: Demographic, clinical, laboratory, and dialysis treatment indicators were used to model 6- and 12-month mortality probability in a HD patients training cohort (n = 6,633) using generalized linear models (GLMs). A total of 10 nephrologists from 5 HD clinics responded to the SQ in 215 patients followed prospectively for 12 months. The performance of PM was evaluated in the validation (n = 6,634) and SQ cohorts (n = 215) using the areas under receiver operating characteristics curves. We compared sensitivities and specificities of PM and SQ. Results: The PM and SQ cohorts comprised 13,267 (mean age 61 years, 55% men, 54% whites) and 215 (mean age 62 years, 59% men, 50% whites) patients, respectively. During the 12-month follow-up, 1,313 patients died in the prediction model cohort and 22 in the SQ cohort. For 6-month mortality prediction, the GLM had areas under the curve of 0.77 in the validation cohort and 0.77 in the SQ cohort. As for 12-month mortality, areas under the curve were 0.77 and 0.80 in the validation and SQ cohorts, respectively. The 6- and 12-month PMs had sensitivities of 0.62 (95% CI 0.35–0.88) and 0.75 (95% CI 0.56–0.94), respectively. The 6- and 12-month SQ sensitivities were 0.23 (95% CI 0.002–0.46) and 0.35 (95% CI 0.14–0.56), respectively. Conclusion: PMs exhibit superior sensitivity compared to the SQ for mortality prognostication in HD patients.

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Development and Validation of a Risk Scoring System for Severe Acute Lower Gastrointestinal Bleeding

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2016.05.042 ◽

2016 ◽

Vol 14 (11) ◽

pp. 1562-1570.e2 ◽

Cited By ~ 41

Author(s):

Tomonori Aoki ◽

Naoyoshi Nagata ◽

Takuro Shimbo ◽

Ryota Niikura ◽

Toshiyuki Sakurai ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Scoring System ◽

Lower Gastrointestinal Bleeding ◽

Risk Scoring ◽

Development And Validation ◽

Risk Scoring System

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External validation of the NOBLADS score, a risk scoring system for severe acute lower gastrointestinal bleeding

PLoS ONE ◽

10.1371/journal.pone.0196514 ◽

2018 ◽

Vol 13 (4) ◽

pp. e0196514 ◽

Cited By ~ 6

Author(s):

Tomonori Aoki ◽

Atsuo Yamada ◽

Naoyoshi Nagata ◽

Ryota Niikura ◽

Yoshihiro Hirata ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Scoring System ◽

External Validation ◽

Lower Gastrointestinal Bleeding ◽

Risk Scoring ◽

Risk Scoring System

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Evaluation of Superselective Transcatheter Arterial Embolization with n-Butyl Cyanoacrylate in Treating Lower Gastrointestinal Bleeding: A Retrospective Study on Seven Cases

Gastroenterology Research and Practice ◽

10.1155/2016/8384349 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 5

Author(s):

Yuan Zhao ◽

Gang Li ◽

Xiang Yu ◽

Ping Xie

Keyword(s):

Retrospective Study ◽

Gastrointestinal Bleeding ◽

Transcatheter Arterial Embolization ◽

Alternative Therapy ◽

Clinical Signs ◽

Arterial Embolization ◽

Lower Gastrointestinal Bleeding ◽

Lower Gastrointestinal Hemorrhage ◽

Intestinal Necrosis ◽

Long Run

Background. To investigate the safety and efficacy of superselective transcatheter arterial embolization (TAE) with n-butyl cyanoacrylate (NBCA) in treating lower gastrointestinal bleeding caused by angiodysplasia.Methods. A retrospective study was performed to evaluate the clinical data of the patients with lower gastrointestinal bleeding caused by angiodysplasia. The patients were treated with superselective TAE with NBCA between September 2013 and March 2015. Angiography was performed after the embolization. The clinical signs including melena, anemia, and blood transfusion treatment were evaluated. The complications including abdominal pain and intestinal ischemia necrosis were recorded. The patients were followed up to evaluate the efficacy in the long run.Results. Seven cases (2 males, 5 females; age of69.55±2.25) were evaluated in the study. The embolization was successfully performed in all cases. About 0.2–0.8 mL (mean0.48±0.19 mL) NCBA was used. Immediate angiography after the embolization operation showed that the abnormal symptoms disappeared. The patients were followed up for a range of 2–19 months and six patients did not reoccur. No serious complications, such as femoral artery puncture point anomaly, vascular injury, and intestinal necrosis perforation were observed.Conclusion. For the patients with refractory and repeated lower gastrointestinal hemorrhage due to angiodysplasia, superselective TAE with NBCA seem to be a safe and effective alternative therapy when endoscopy examination and treatment do not work.

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