MH-STRALP: A scoring system for prognostication in patients with upper gastrointestinal bleeding

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Abstract

BACKGROUND

Upper gastrointestinal bleeding (UGIB) is a common medical emergency and early assessment of its outcomes is vital for treatment decisions.

AIM

To develop a new scoring system to predict its prognosis.

METHODS

In this retrospective study, 692 patients with UGIB were enrolled from two centers and divided into a training ( n = 591) and a validation cohort ( n = 101). The clinical data were collected to develop new prognostic prediction models. The endpoint was compound outcome defined as (1) demand for emergency surgery or vascular intervention, (2) being transferred to the intensive care unit, or (3) death during hospitalization. The models’ predictive ability was compared with previously established scores by receiver operating characteristic (ROC) curves.

RESULTS

Totally 22.2% (131/591) patients in the training cohort and 22.8% (23/101) in the validation cohort presented poor outcomes. Based on the stepwise-forward Logistic regression analysis, eight predictors were integrated to determine a new post-endoscopic prognostic scoring system (MH-STRALP); a nomogram was determined to present the model. Compared with the previous scores (GBS, Rockall, ABC, AIMS65, and PNED score), MH-STRALP showed the best prognostic prediction ability with area under the ROC curves (AUROCs) of 0.899 and 0.826 in the training and validation cohorts, respectively. According to the calibration curve, decision curve analysis, and internal cross-validation, the nomogram showed good calibration ability and net clinical benefit in both cohorts. After removing the endoscopic indicators, the pre-endoscopic model (pre-MH-STRALP score) was conducted. Similarly, the pre-MH-STRALP score showed better predictive value (AUROCs of 0.868 and 0.767 in the training and validation cohorts, respectively) than the other pre-endoscopic scores.

CONCLUSION

The MH-STRALP score and pre-MH-STRALP score are simple, convenient, and accurate tools for prognosis prediction of UGIB, and may be applied for early decision on its management strategies.

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Most cited references 50

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Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Spencer L James, Degu Abate, Kalkidan Hassen Abate … (2020)

Summary Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. Methods We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. Findings Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1–4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0–8·4) while the total sum of global YLDs increased from 562 million (421–723) to 853 million (642–1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6–9·2) for males and 6·5% (5·4–7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782–3252] per 100 000 in males vs s1400 [1279–1524] per 100 000 in females), transport injuries (3322 [3082–3583] vs 2336 [2154–2535]), and self-harm and interpersonal violence (3265 [2943–3630] vs 5643 [5057–6302]). Interpretation Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury. Funding Bill & Melinda Gates Foundation.

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Risk assessment after acute upper gastrointestinal haemorrhage.

T A Rockall, R. F. Logan, H Devlin … (1996)

The aim of this study was to establish the relative importance of risk factors for mortality after acute upper gastrointestinal haemorrhage, and to formulate a simple numerical scoring system that categorizes patients by risk. A prospective, unselected, multicentre, population based study was undertaken using standardised questionnaires in two phases one year apart. A total of 4185 cases of acute upper gastrointestinal haemorrhage over the age of 16 identified over a four month period in 1993 and 1625 cases identified subsequently over a three month period in 1994 were included in the study. It was found that age, shock, comorbidity, diagnosis, major stigmata of recent haemorrhage, and rebleeding are all independent predictors of mortality when assessed using multiple logistic regression. A numerical score using these parameters has been developed that closely follows the predictions generated by logistical regression equations. Haemoglobin, sex, presentation (other than shock), and drug therapy (non-steroidal anti-inflammatory drugs and anticoagulants) are not represented in the final model. When tested for general applicability in a second population, the scoring system was found to reproducibly predict mortality in each risk category. In conclusion, a simple numerical score can be used to categorize patients presenting with acute upper gastrointestinal haemorrhage by risk of death. This score can be used to determine case mix when comparing outcomes in audit and research and to calculate risk standardised mortality. In addition, this risk score can identify 15% of all cases with acute upper gastrointestinal haemorrhage at the time of presentation and 26% of cases after endoscopy who are at low risk of rebleeding and negligible risk of death and who might therefore be considered for early discharge or outpatient treatment with consequent resource savings.

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ACG clinical guideline: Evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE).

Evan Dellon, Nirmala Gonsalves, Ikuo Hirano … (2013)

Esophageal eosinophilia and eosinophilic esophagitis (EoE) are increasingly recognized and prevalent conditions, which now represent common clinical problems encountered by gastroenterologists, pathologists, and allergists. The study of EoE has become a dynamic field with an evolving understanding of the pathogenesis, diagnosis, and treatment. Although there are limited data supporting management decisions, clinical parameters are needed to guide the care of patients with eosinophilic-esophageal disorders. In this evidence-based review, recommendations developed by adult and pediatric gastroenterologists are provided for the evaluation and management of these patients. New terminology is emphasized, particularly the concepts of esophageal eosinophilia and proton-pump inhibitor-responsive esophageal eosinophilia (PPI-REE) as entities distinct from EoE.

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Author and article information

Contributors

Jun-Nan Hu

Fei Xu

Ya-Rong Hao

Chun-Yan Sun

Kai-Ming Wu

Yong Lin

Lan Zhong

Xin Zeng

Journal

Journal ID (nlm-ta): World J Gastrointest Surg

Journal ID (publisher-id): WJGS

Title: World Journal of Gastrointestinal Surgery

Publisher: Baishideng Publishing Group Inc

ISSN (Electronic): 1948-9366

Publication date (Print): 27 March 2024

Publication date (Electronic): 27 March 2024

Volume: 16

Issue: 3

Pages: 790-806

Affiliations

Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China

Department of Gastroenterology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai 200003, China

Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China

Department of Gastroenterology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai 200003, China

Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China

Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China. zengxinmd1978@ 123456163.com

Author notes

Co-first authors: Jun-Nan Hu and Fei Xu.

Co-corresponding authors: Lan Zhong and Xin Zeng.

Author contributions: Hu JN, Xu F were involved in investigation, acquisition, data collection, and drafting of the manuscript; Sun CY, Wu KM were involved in analysis of data; Hao YR was involved in investigation, acquisition, data collection; Lin Y was involved in concept and design, gathering conflict-of-interest forms and statements, are properly completed; Zhong L, Zeng X were involved in providing details of authorship, acquisition and interpretation of funding, ethics committee approval documentation, review and edit the manuscript. All authors were involved in the critical review of the results and have contributed to, read, and approved the final manuscript. Hu JN and Xu F contributed equally to this work as co-first authors. The reasons for designating Hu JN and Xu F as co-first authors are as follows. They have equally contributed to the project by leading and executing a critical component of the research, namely developing the computational model, solving pivotal theoretical problems. They also shared equal responsibility in the process of writing, editing, and refining the manuscript, as well as preparing the visualizations that greatly enhance the clarity and impact of the work. Zhong L and Zeng X contributed equally to this work as co-corresponding authors. The reasons for designating Zhong L and Zeng X as co-corresponding authors are as follows. Zhong L and Zeng X played a crucial role in providing author details, acquiring and interpreting funding, obtaining ethics committee approval documents, and revising and editing the manuscript. The contributions of both authors were essential for the smooth progress of the research and the writing of the final paper, reflecting their significant leadership and coordination role throughout the research process. Their expertise and contributions were indispensable in ensuring the quality and integrity of the study. By involving themselves in every key stage of the project and bearing the responsibility of ensuring the research adhered to ethical and funding body standards, the designation of co-corresponding authors serves as recognition of their significant work. Moreover, they ensured that the paper had proper technical and administrative support during the submission process and after publication, guaranteeing high standards and transparency for the research and manuscript. Therefore, appointing Zhong L and Zeng X as co-corresponding authors is a fair and appropriate reflection of their substantial contributions and corresponding responsibilities to this research. This research was completed as a result of collaborative teamwork, and designating co-first authors and co-corresponding authors accurately reflects the distribution of responsibility and the burden of time and effort required to complete the study and the manuscript. It also embodies our team’s spirit of collaboration, the equitable contributions, and the diversity present within our group.

Supported by Key Disciplines Group Construction Project of Shanghai Pudong New Area Health Commission, No. PWZxq2022-06; Medical discipline Construction Project of Pudong Health Committee of Shanghai, No. PWYgf2021-02; Joint Tackling Project of Pudong Health Committee of Shanghai, No. PW2022D08; and the Medical Innovation Research Project of the Shanghai Science and Technology Commission , No. 22Y11908400.

Corresponding author: Xin Zeng, MD, PhD, Chief Doctor, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, No. 150 Jimo Road, Shanghai 200120, China. zengxinmd1978@ 123456163.com

Article

Other ID: jWJGS.v16.i3.pg790 Publisher-manuscript ID: 91131

DOI: 10.4240/wjgs.v16.i3.790

PMC ID: 10989336

PubMed ID: 38577095

SO-VID: 67d23b4d-2ccd-44f0-9c8b-13fefc16cd08

License:

This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

History

Date received : 22 December 2023

Date revision received : 21 January 2024

Date accepted : 29 February 2024

MH-STRALP: A scoring system for prognostication in patients with upper gastrointestinal bleeding

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Abstract

BACKGROUND

AIM

METHODS

RESULTS

CONCLUSION

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Most cited references 50

Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Risk assessment after acute upper gastrointestinal haemorrhage.

ACG clinical guideline: Evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE).

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