Risk Factors And Model Prediction Of Rebleeding In Acute Upper Gastrointestinal Hemorrhage

Objective The risk factors of rebleeding in patients with acute upper gastrointestinal bleeding(AUGIB)were analyzed,and the prediction model was constructed by using risk factors,and its prediction accuracy was compared with the AIMS65 scoring system.MethodRetrospective analysis was performed on 390 patients who presented with AUGIB in the emergency room of Fujian Provincial Hospital from October 2019 to October 2020 and completed emergency gastroscopy within 24-48 hours.Patients were divided into two groups according to whether they had rebleeding after hemostasis treatment during hospitalization.The basic information,clinical symptoms,signs and laboratory indicators of patients were collected and analyzed.The measurement data were analyzed by independent sample t test or nonparametric test,and the counting data were analyzed by chi-square test,corrected chi-square test or Fisher’s exact test.Univariate and multivariate Logistic regression analysis were performed,and indicators with P < 0.1were listed as risk factors to form a new prediction model.Compared the prediction value between the new prediction model and the AIMS65 score.Results1.A total of 390 AUGIB patients were collected in this study including 48 cases of rebleeding(12.3%)and 342 cases of no rebleeding(87.7%).The ratio of men to women is about 3.3:1.Peptic ulcer was the main cause of AUGIB(59%),followed by esophageal and gastric variceal hemorrhage(17.4%)and upper digestive tract tumor(8.7%).2.There were statistically significant differences in hematemesis,lactic acid,neutral lobular nucleus ratio,red blood cell count,red blood cell distribution width,platelet,albumin,prothrombin time,activated partial thromboplastin time,thrombin time,fibrinogen,plasma D-dimer and AIMS65 score between the rebleeding group and the non-rebleeding group(all P < 0.05).3.Single factor in the Logistic regression analysis(P < 0.1)was age,hematemesis,lactic acid,neutral lobular nuclear ratior,red blood cell count,erythrocyte,platelet distribution width,albumin,prothrombin time,thrombin time,fibrinogen,and plasma D-dimer.These variables were included in the multivariate Logistic regression analysis.The results showed that the P values of lactic acid,plasma D-dimer and platelet were all less than 0.1,platelet was a protective factor for AUGIB rebleeding,while plasma D-dimer,lactic acid were all risk factors for AUGIB rebleeding.4.The three meaningful indexes in multivariate Logistic regression analysis were constructed into a new prediction model,which was compared with the area under the ROC curve and the sensitivity and specificity of the AIMS65 score.The results showed that the AUC of AIMS65 was 0.616(95%CI 0.529-0.704,P =0.009),the sensitivity was41.7%,and the specificity was 78.4%.The AUC of the prediction model was0.728(95%CI 0.644-0.812,P =0.000),the sensitivity was 56.3%,and the specificity was85.4%.The sensitivity and specificity of the prediction model were higher than those of the AIMS65 score,and the difference was statistically significant(P <0.05).The results show that the new prediction model is better than the AIMS65 score in predicting AUGIB patients’ rebleeding.Conclusion1.AUGIB is often seen in men and mainly caused by peptic ulcer.2.Lactate and plasma D-dimer are risk factors for rebleeding in AUGIB patients and platelet is the protective factor for rebleeding in AUGIB patients.3.The prediction model constructed by the combination of lactic acid,platelet,and plasma D-dimer is superior to AIMS65 score.