Development and validation of a model to predict rebleeding within three days after endoscopic hemostasis for high-risk peptic ulcer bleeding

Yongkang Lai, Yuling Xu, Zhenhua Zhu, Xiaolin Pan, Shunhua Long, Wangdi Liao, Bimin Li, Yin Zhu, Youxiang Chen, Xu Shu, Yongkang Lai, Yuling Xu, Zhenhua Zhu, Xiaolin Pan, Shunhua Long, Wangdi Liao, Bimin Li, Yin Zhu, Youxiang Chen, Xu Shu

Abstract

Background: Peptic ulcer bleeding remains a typical medical emergency with significant morbidity and mortality. Peptic ulcer rebleeding often occurs within three days after emergent endoscopic hemostasis. Our study aims to develop a nomogram to predict rebleeding within three days after emergent endoscopic hemostasis for high-risk peptic ulcer bleeding.

Methods: We retrospectively reviewed the data of 386 patients with bleeding ulcers and high-risk stigmata who underwent emergent endoscopic hemostasis between March 2014 and October 2018. The least absolute shrinkage and selection operator method was used to identify predictors. The model was displayed as a nomogram. Internal validation was carried out using bootstrapping. The model was evaluated using the calibration plot, decision-curve analyses, and clinical impact curve.

Results: Overall, 386 patients meeting the inclusion criteria were enrolled, with 48 patients developed rebleeding within three days after initial endoscopic hemostasis. Predictors contained in the nomogram included albumin, prothrombin time, shock, haematemesis/melena and Forrest classification. The model showed good discrimination and good calibration with a C-index of 0.854 (C-index: 0.830 via bootstrapping validation). Decision-curve analyses and clinical impact curve also demonstrated that it was clinically valuable.

Conclusion: This study presents a nomogram that incorporates clinical, laboratory, and endoscopic features, effectively predicting rebleeding within three days after emergent endoscopic hemostasis and identifying high-risk rebleeding patients with peptic ulcer bleeding. Trial registration This clinical trial has been registered in the ClinicalTrials.gov (ID: NCT04895904) approved by the International Committee of Medical Journal Editors (ICMJE).

Keywords: Emergency endoscopic hemostasis; LASSO; Nomogram; Peptic ulcer bleeding; Rebleeding.

Conflict of interest statement

All authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
The flowchart of patients included in the present study
Fig. 2
Fig. 2
Predictors selection based on the least absolute shrinkage and selection operator (LASSO) regression. A LASSO Select Model ([lambda]) of the adjustment parameter by the minimum standard, and tenfold cross-validation. Use log(λ) to plot the area under the receiver operating characteristic curve. Draw a vertical dashed line at the optimal value with one standard error of the minimum standard and 1 standard error of the minimum standard (1-SE standard). B The tuning parameter (lambda) selection in LASSO regression uses tenfold cross-validation. The binomial deviation is plotted on the logarithm (lambda). Use the 1-SE standard to draw a dashed line at the optimal value
Fig. 3
Fig. 3
Nomogram predicting the probability of rebleeding within three days following endoscopic therapy for peptic ulcer bleeding
Fig. 4
Fig. 4
Calibration curves of the nomogram in the primary cohort
Fig. 5
Fig. 5
A Decision curve analysis for the nomogram; B clinical impact curve for the nomogram
Fig. 6
Fig. 6
Comparison of ROC among the nomogram, Glasgow-Blatchford score system, Rockall score system and AIMS65 score system. ROC receiver operating characteristic, GBS Glasgow-Blatchford score

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