背景:尽管目前的指南推荐内镜联合治疗,内镜下肾上腺素注射(EI)单一疗法仍然是一种简单的,治疗消化性溃疡出血(PUB)的常见和有效的方式。然而,EI单药治疗后再出血的风险仍然很高,目前尚不清楚EI单药治疗后再出血患者的身份,这在临床实践中非常重要。本研究旨在确定危险因素,并构建与EI单药治疗后再出血相关的预测列线图。
方法:我们连续和回顾性分析了2014年3月至2021年7月在我们中心接受EI单药治疗的360例PUB患者。然后,我们通过多因素logistic回归确定了与初次内镜下EI单药治疗后再出血相关的独立危险因素。基于上述预测因子开发并验证了预测列线图。
结果:在所有纳入的PUB患者中,51(14.2%)在内镜下EI单药治疗后30天内出现复发性出血。经过多变量逻辑回归,休克[优势比(OR)=12.691,95%置信区间(CI)5.129-31.399,p<0.001],Rockall评分(OR=1.877,95%CI1.250-2.820,p=0.002),心动过速(心率>100次/分钟)(OR=2.610,95%CI1.098-6.203,p=0.030),凝血酶原时间延长(PT>13s)(OR=2.387,95%CI1.019-5.588,p=0.045)和胃溃疡(OR=2.258,95%CI1.003-5.084,p=0.049)与初始EI单药治疗后再出血风险增加相关.包含这些独立高风险因素的列线图显示出良好的区分度,受试者工作特征曲线下面积(AUROC)为0.876(95%CI0.817-0.934)(p<0.001)。
结论:我们建立了EI单药治疗后再出血的预测列线图,具有良好的预测精度。该预测列线图可方便地用于识别EI单药治疗后的低危再出血患者。允许在临床环境中做出决策。
BACKGROUND: Although the current guidelines recommend endoscopic combination therapy, endoscopic epinephrine injection (EI) monotherapy is still a simple, common and effective modality for treating peptic ulcer bleeding (PUB). However, the rebleeding risk after EI monotherapy is still high, and identifying rebleeding patients after EI monotherapy is unclear, which is highly important in clinical practice. This
study aimed to identify risk factors and constructed a predictive nomogram related to rebleeding after EI monotherapy.
METHODS: We consecutively and retrospectively analyzed 360 PUB patients who underwent EI monotherapy between March 2014 and July 2021 in our center. Then we identified independent risk factors associated with rebleeding after initial endoscopic EI monotherapy by multivariate logistic regression. A predictive nomogram was developed and validated based on the above predictors.
RESULTS: Among all PUB patients enrolled, 51 (14.2%) had recurrent hemorrhage within 30 days after endoscopic EI monotherapy. After multivariate logistic regression, shock [odds ratio (OR) = 12.691, 95% confidence interval (CI) 5.129-31.399, p < 0.001], Rockall score (OR = 1.877, 95% CI 1.250-2.820, p = 0.002), tachycardia (heart rate > 100 beats/min) (OR = 2.610, 95% CI 1.098-6.203, p = 0.030), prolonged prothrombin time (PT > 13 s) (OR = 2.387, 95% CI 1.019-5.588, p = 0.045) and gastric ulcer (OR = 2.258, 95% CI 1.003-5.084, p = 0.049) were associated with an increased risk of rebleeding after an initial EI monotherapy treatment. A nomogram incorporating these independent high-risk factors showed good discrimination, with an area under the receiver operating characteristic curve (AUROC) of 0.876 (95% CI 0.817-0.934) (p < 0.001).
CONCLUSIONS: We developed a predictive nomogram of rebleeding after EI monotherapy, which had excellent prediction accuracy. This predictive nomogram can be conveniently used to identify low-risk rebleeding patients after EI monotherapy, allowing for decision-making in a clinical setting.