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A Nomogram Model for Prediction of Mortality Risk of Patients with Dangerous Upper Gastrointestinal Bleeding: A Two-center Retrospective Study

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Abstract

Objective

This study aimed to establish a nomogram model to predict the mortality risk of patients with dangerous upper gastrointestinal bleeding (DUGIB), and identify high-risk patients who require emergent therapy.

Methods

From January 2020 to April 2022, the clinical data of 256 DUGIB patients who received treatments in the intensive care unit (ICU) were retrospectively collected from Renmin Hospital of Wuhan University (n=179) and the Eastern Campus of Renmin Hospital of Wuhan University (n=77). The 179 patients were treated as the training cohort, and 77 patients as the validation cohort. Logistic regression analysis was used to calculate the independent risk factors, and R packages were used to construct the nomogram model. The prediction accuracy and identification ability were evaluated by the receiver operating characteristic (ROC) curve, C index and calibration curve. The nomogram model was also simultaneously externally validated. Decision curve analysis (DCA) was then used to demonstrate the clinical value of the model.

Results

Logistic regression analysis showed that hematemesis, urea nitrogen level, emergency endoscopy, AIMS65, Glasgow Blatchford score and Rockall score were all independent risk factors for DUGIB. The ROC curve analysis indicated the area under curve (AUC) of the training cohort was 0.980 (95%CI: 0.962–0.997), while the AUC of the validation cohort was 0.790 (95%CI:0.685–0.895). The calibration curves were tested for Hosmer-Lemeshow goodness of fit for both training and validation cohorts (P=0.778, P=0.516).

Conclusion

The developed nomogram is an effective tool for risk stratification, early identification and intervention for DUGIB patients.

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Acknowledgements

We thank Li-long ZHANG and Li HUANG for their help in revision of this manuscript.

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Author notes

  1. These authors contributed equally to this work.

Authors and Affiliations

  1. Department of Intensive Care Unit, Renmin Hospital of Wuhan University, Wuhan, 430060, China

    Zhou Liu, Guang Li, Gui-jun Jiang & Li-ying Zhan

  2. Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, 430060, China

    Liang Zhang

  3. Department of Hepatobiliary Surgery, Renmin Hospital of Wuhan University, Eastern Campus, Wuhan, 430200, China

    Wen-hui Bai

  4. Department of Gastroenterology, The First People’s Hospital of Jingzhou, Jingzhou, 434000, China

    Pei-xue Wang

  5. Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, 430060, China

    Pei-xue Wang, Ji-xiang Zhang & Wei-guo Dong

  6. Department of Intensive Care Unit, Renmin Hospital of Wuhan University, Eastern Campus, Wuhan, 430200, China

    Li Cheng

Authors
  1. Zhou Liu
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  2. Liang Zhang
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  3. Guang Li
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Corresponding authors

Correspondence to Li-ying Zhan, Li Cheng or Wei-guo Dong.

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All authors declare no conflict of interest in this research.

Additional information

This work was supported by Wuhan Scientific Research Project (No. EX20B05) and National Nature Science Foundation of China (No. 82000521).

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Liu, Z., Zhang, L., Li, G. et al. A Nomogram Model for Prediction of Mortality Risk of Patients with Dangerous Upper Gastrointestinal Bleeding: A Two-center Retrospective Study. CURR MED SCI 43, 723–732 (2023). https://doi.org/10.1007/s11596-023-2748-z

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  • DOI: https://doi.org/10.1007/s11596-023-2748-z

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