Analysis Of Risk Factors For Delayed Bleeding After Endoscopic Treatment Of Colonic Polyps And Construction Of Nomogram

ObjectiveTo explore the risk factors related to delayed bleeding after endoscopic treatment of colon polyps,construct a graph prediction model of the risk of delayed bleeding and evaluate the prediction efficiency,so as to help clinicians identify patients with high risk of delayed bleeding through the graph,and reduce the missed diagnosis and misdiagnosis of delayed bleeding after endoscopic treatment of colon polyps.MethodsClinical data of 2616 patients who underwent endoscopic treatment for colon polyps in Qingdao Municipal Hospital from January 2021 to January2022 were retrospectively analyzed.According to whether delayed bleeding occurred after endoscopic treatment,the patients were divided into delayed bleeding group and no bleeding group.The difference of clinical data between the two groups was compared by chi-square test.The independent risk factors for delayed bleeding were discussed by binary Logistic multivariate regression analysis.Based on the results of multi-factor regression analysis,R software and rms package were used to construct a nomogram model for predicting the risk of delayed bleeding.Bootstrap self-sampling method was used for internal verification.The consistency index(C-index)was calculated by rms package and Calibration curve was used to evaluate the calibration degree.The reliability of the nomogram was evaluated by C-index and calibration curve.ResultsIn this study,clinical data of 2616 patients with endoscopic treatment of colon polyps were collected,including 1602 males and 1014 females,with an average age of(56.2±9.5)years.A total of 72 patients had delayed hemorrhage after endoscopic treatment of colon polyps,with an incidence of 2.75%.Most of the bleeding occurred within 1 week after surgery,with an average age of(2.07±1.32)days.60 cases occurred within 1 to 2 days and 12 cases within 3 to6 days.1.72 patients with delayed hemorrhage were in general condition: 37 males(51.4%)and 35 females(48.6%);There were 57 cases(79.2%)aged ≥60 years and 15 cases(20.8%)aged <60 years.64 cases(88.9%)were combined with hypertension.Combined with coronary heart disease in 18 cases(25%);There were 15 cases(20.8%)with diabetes mellitus.25 cases(34.7%)were combined with hyperlipidemia.Cirrhosis was associated with 14 cases(19.4%).55 cases(76.4%)were complicated with arteriosclerosis.20 cases(27.8%)took antithrombotic drugs for a long time;There were 16 cases(22.2%)with Body Mass Index(BMI)≥28kg/m~2 and 56 cases(77.8%)with Body Mass Index(BMI)<28kg/m~2.There were 36 cases(50.0%)of adenomatous polyps and 36cases(50.0%)of non-adenomatous polyps.Colon polyps were treated by EMR in 55 cases(76.4%)and ESD in 17 cases(23.6%).There were 10 cases(13.9%)of polyps with or without pedicle,and 62 cases(86.1%)of polyps without pedicle.There were 37 cases(51.4%)of single polyps and 35 cases(48.6%)of multiple polyps.The polyp size ≥1.5cm60 cases(83.3%),polyp size <1.5cm12cases(16.7%);There were 16(22.2%)polyps in the right half colon and 56(77.8%)polyps in the left half colon.2.The χ~2 test showed that age,combined hypertension,cirrhosis,arteriosclerosis,long-term oral antithrombotic drugs,surgical method,polyp shape,polyp number,polyp size and polyp location were related to the occurrence of delayed hemorrhage(all P<0.05).3.Binary Logistic multivariate regression analysis was performed on the results obtained from univariate analysis.The results showed that age ≥60 years old,combined with hypertension,combined with arteriosclerosis,combined with cirrhosis,long-term oral antithrombotic drugs,flat or pedicular polyps,and polyp diameter ≥1.5cm were independent risk factors for delayed hemorrhage(all P<0.05).4.According to the results of multi-factor analysis,R software was used to build a nomogram prediction model of the occurrence risk of delayed bleeding.The consistency index(C index)of the predicted model was 0.958,and the consistency index(C index)of the verified model was 0.955,indicating good prediction efficiency.R software was used to draw the calibration curve.The calibration curve indicated that the predicted risk of delayed bleeding was in good agreement with the actual risk curve,and the nomogram had good prediction accuracy.Conclusion1.This study established that age ≥60 years old,combined with hypertension,arteriosclerosis,cirrhosis,long-term oral antithrombotic drugs,flat or pedicular polyps,and polyp diameter ≥1.5cm were independent risk factors for delayed bleeding after endoscopic treatment of colon polyps.2.The risk nomogram of delayed hemorrhage constructed in this study has good predictive ability and high accuracy.The risk of delayed bleeding can be predicted using patient clinical data combined with a nomogram.In clinical practice,it can help physicians identify patients at higher risk of bleeding.