老年患者急性上消化道再出血风险预测模型的建立

Establishment of a risk prediction model for acute upper gastrointestinal rebleeding in elderly patients

目的联合运用多个指标建立老年患者急性上消化道再出血(AUGIRB)风险模型。方法回顾性分析2018年7月至2020年12月上海市第一人民医院收治的161例老年(年龄≥65岁)急性上消化道出血(AUGIB)患者的临床资料,根据是否合并消化道再出血分为再出血组(31例)和无再出血组(130例)。应用单因素分析筛选AUGIRB相关危险因素,Logistic回归分析筛选AUGIRB独立预测指标,构建预测模型。通过受试者工作特征(ROC)曲线下面积(AUC)评估预测模型对AUGIRB的预测能力,确定最佳截断值,计算优势比(OR)及其95%可信区间(95%CI)。运用Bootstrap重抽样法对模型的预测能力进行内部验证。结果单因素分析发现,口服抗凝药物和抗血小板药物、白蛋白(ALB)、血小板计数(PLT)、格拉斯哥-布拉奇福德出血评分(GBS)、D-二聚体、纤维蛋白原(FIB)和国际标准化比值(INR)对老年患者是否发生AUGIRB有显著影响。多因素Logistic回归分析显示,口服抗血小板药物(OR=11.150,95%CI:1.888~65.852,P<0.05)、GBS评分(OR=2.503,95%CI:1.523~4.114,P<0.05)为老年患者合并AUGIRB的独立危险因素,ALB(OR=0.764,95%CI:0.626~0.932,P<0.05)和FIB(OR=0.065,95%CI:0.011~0.370,P<0.05)为老年患者合并AUGIRB的保护因素。上述4个指标联合预测模型的AUC为0.979。模型预测能力的内部验证表明,C指数为0.986。结论研究中拟合的预测模型预测准确率较高,对老年患者合并AUGIRB的判断有一定参考价值。

Objective To establish a prediction model of acute upper gastrointestinal rebleeding(AUGIRB)for elderly patients by combining and applying multiple indicators.Methods A retrospective observational study was conducted.The clinical data of 161 elderly patients(age≥65 years old)who suffered from acute upper gastrointestinal bleeding(AUGIB)and who were hospitalized in Shanghai General Hospital from July 2018 to December 2020 were recorded.The patients were divided into the rebleeding group(31 cases)and the non-rebleeding group(130 cases)according to whether gastrointestinal rebleeding occurred.Univariate analysis was adopted to screen AUGIRB-related risk factors and Logistic regression analysis was used to screen independent predictors of AUGIRB so that a predictive model was constructed.Based on the area under the curve(AUC)of the receiver operator characteristic curve(ROC curve),the predictive ability of the prediction model for AUGIRB was evaluated,the optimal cut-off value was determined,and the odds ratio(OR)and its 95%confidence interval(95%CI)were calculated.Bootstrap resampling technology was used to validate the predictive ability of the model.Results Univariate Logistic analysis showed that oral anticoagulant drugs,oral antiplatelet drugs,albumin(ALB),platelet count(PLT),Glasgow-Blatchford bleeding score(GBS),D-dimer,fibrinogen(FIB),and international normalized ratio(INR)all had a significant effect on the occurrence of AUGIRB among elderly patients.Multivariate Logistic regression analysis showed that the oral antiplatelet drugs(OR=11.150,95%CI was 1.888-65.852,P<0.05)and GBS score(OR=2.503,95%CI was 1.523-4.114,P<0.05)were the independent risk factors of AUGIRB among elderly patients,while the ALB(OR=0.764,95%CI was 0.626-0.932,P<0.05)and FIB(OR=0.065,95%CI was 0.011-0.370,P<0.05)were the protective factors of AUGIRB among elderly patients.The AUC of the above four indexes joint prediction model was 0.979.The verification results of the model showed that the consistency index(C-index)of the model was 0.986.Conclusion The prediction model fitted in this research has a high prediction accuracy and it also has a certain reference value for the judgment of elderly patients who suffer from AUGIRB.