Construction And Effect Evaluation Of Risk Score For Gastrointestinal Bleeding In Stroke Patients

ObjectiveTo established the risk assessment table of gastrointestinal bleeding in stroke patients and verify its predictive effect.Methods1.Risk factors for gastrointestinal bleeding in stroke patients were identified by Meta analysis.Computer retrieval domestic part of the digestive tract hemorrhage in patients with stroke risk factors analysis of case-control studies and cohort studies,the Newcastle-Ottawa scale to evaluate the quality of literature,the Rev Man5.3 software heterogeneity inspection(inspection level alpha = 0.1),the sensitivity analysis of count data with odds ratio(OR)as effect index.2.Based on the results of Meta-analysis,the evaluation scale of gastrointestinal bleeding risk of stroke patients was established.The results of meta-analysis were initially included to identify statistically significant risk factors.After two rounds of face-to-face consultation between researchers and experts,the risk assessment table was constructed based on the composition ratio of OR values of each risk factor in meta-analysis.3.Verify the constructed risk rating scale in actual clinical scenarios.Retrospective analysis was performed on inpatients with stroke from July to October 2019 in a third-level first-class hospital,and the risk score value of each patient was calculated to verify the predictive effect of the rating scale.The area under the ROC curve was used to evaluate its predictive power.The maximum value of the Jordan index was taken as the optimal cut-off value,and the patients were divided into the high-risk group and the low-risk group according to the cut-off value.The difference in the incidence of gastrointestinal bleeding between the two groups was analyzed for statistical significance.Results1.A total of 17 literatures were included in the meta-analysis,and 30 related factors were analysis.The results showed that “age”,“gender”,“atrial fibrillation”,“heart failure”,“renal insufficiency”,“chronic pulmonary diseases”,“liver diseases”,“history of digestive tract diseases”,“coagulopathy”,“sepsis”,“infarction location”,“lesion location”,“breaking into ventricle”,“pupillary asymmetry”,“GCS score”,“impairment of consciousness”,“thrombolytic therapy”,“steroids”,“hyperlipidemia” a total of 19 factors associated with gastrointestinal bleeding in patients with stroke(P<0.05),among them,“hyperlipidemia” for the protection factor,the rest for risk factors.The other 11 items had no statistical significance(P>0.05).2.After two rounds of consultation with a total of 11 experts in neurology,neurosurgery,gastroenterology and epidemiological statistics,the adjustment results of risk rating scale were obtained: the two entries of “infarction location” and “impairment of consciousness” were deleted,and “ pupillary asymmetry” was changed to “brain hernia”.Replace “chronic pulmonary diseases” with “pulmonary disease”;Items on the rating scale should be sorted by disease system and category of items;The total score was 100 points,and the value was assigned according to the proportion of OR value of each risk factor item in the sum of OR value of all risk factor items on the rating scale.3.A review of case data of a third-grade a general hospital in Guangzhou from July to October 2019 showed that there was a statistically significant difference in risk score between the gastrointestinal bleeding group(61 cases)and the non-bleeding group(446 cases)(P < 0.05).When the area under the ROC curve was 0.840 and the cut-off value was 7.5,the Youden index was the largest(0.543),the sensitivity and specificity were 85.2% and 69.1%,respectively,and the positive likelihood ratio and negative likelihood ratio were 2.76 and 0.21,respectively.The total score of the score scale was 100,0-7 was divided into the low-risk group and 8-100 into the high-risk group.The actual incidence of gastrointestinal bleeding in the two groups was statistically significant(P<0.001).Conclusions1.“Sepsis”,“pupillary asymmetry”,“liver disease”,“GCS score”,“impairment of consciousness”,“history of digestive tract disease”,“infarction location”,“breaking into ventricle”,“coagulopathy”,“steroids”,“renal insufficiency”,“lesion location”,“heart failure”,“atrial fibrillation”,“age”,“chronic pulmonary diseases”,“thrombolytic therapy” and “gender” as a risk factor for gastrointestinal bleeding in patients with cerebral apoplexy.2.The risk assessment table for gastrointestinal bleeding in stroke patients constructed based on meta-analysis and expert opinions is scientific and practical,and has a good ability of empirical prediction,which can provide certain reference for clinical screening of high-risk patients and development of predictive nursing strategies.