Development of a prognostic nomogram for cirrhotic patients with upper gastrointestinal bleeding

被引:13
|
作者
Zhou, Yu-Jie [1 ,3 ]
Zheng, Ji-Na [1 ,3 ]
Zhou, Yi-Fan [1 ,3 ]
Han, Yi-Jing [1 ,3 ]
Zou, Tian-Tian [1 ,4 ]
Liu, Wen-Yue [2 ]
Braddock, Martin [6 ]
Shi, Ke-Qing [1 ,5 ]
Wang, Xiao-Dong [1 ,5 ]
Zheng, Ming-Hua [1 ,5 ]
机构
[1] Wenzhou Med Univ, Affiliated Hosp 1, Liver Res Ctr, Dept Hepatol, 2 Fuxue Lane, Wenzhou 325000, Peoples R China
[2] Wenzhou Med Univ, Affiliated Hosp 1, Dept Endocrinol, Wenzhou, Peoples R China
[3] Wenzhou Med Univ, Sch Clin Med Sci 1, Wenzhou, Peoples R China
[4] Wenzhou Med Univ, Sch Clin Med Sci 2, Wenzhou, Peoples R China
[5] Wenzhou Med Univ, Inst Hepatol, Wenzhou, Peoples R China
[6] AstraZeneca R&D, Global Med Dev, Loughborough, Leics, England
基金
中国国家自然科学基金;
关键词
critically ill cirrhosis; mortality risk; nomogram; upper gastrointestinal bleeding; IN-HOSPITAL MORTALITY; ORGAN FAILURE ASSESSMENT; GLASGOW-BLATCHFORD; SCORING SYSTEMS; VARICEAL HEMORRHAGE; LIVER-FUNCTION; MANAGEMENT; OUTCOMES; SCORES; TRANSFUSION;
D O I
10.1097/MEG.0000000000000943
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background and aim Upper gastrointestinal bleeding (UGIB) is a complication with a high mortality rate in critically ill patients presenting with cirrhosis. Today, there exist few accurate scoring models specifically designed for mortality risk assessment in critically ill cirrhotic patients with upper gastrointestinal bleeding (CICGIB). Our aim was to develop and evaluate a novel nomogram-based model specific for CICGIB. Patients and methods Overall, 540 consecutive CICGIB patients were enrolled. On the basis of Cox regression analyses, the nomogram was constructed to estimate the probability of 30-day, 90-day, 270-day, and 1-year survival. An upper gastrointestinal bleeding-chronic liver failure-sequential organ failure assessment (UGIB-CLIF-SOFA) score was derived from the nomogram. Performance assessment and internal validation of the model were performed using Harrell's concordance index (C-index), calibration plot, and bootstrap sample procedures. UGIB-CLIF-SOFA was also compared with other prognostic models, such as CLIF-SOFA and model for end-stage liver disease, using C-indices. Results Eight independent factors derived from Cox analysis (including bilirubin, creatinine, international normalized ratio, sodium, albumin, mean artery pressure, vasopressin used, and hematocrit decrease>10%) were assembled into the nomogram and the UGIB-CLIF-SOFA score. The calibration plots showed optimal agreement between nomogram prediction and actual observation. The C-index of the nomogram using bootstrap (0.729; 95% confidence interval: 0.689-0.766) was higher than that of the other models for predicting survival of CICGIB. Conclusion We have developed and internally validated a novel nomogram and an easy-to-use scoring system that accurately predicts the mortality probability of CICGIB on the basis of eight easy-to-obtain parameters. External validation is now warranted in future clinical studies. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
引用
收藏
页码:1166 / 1173
页数:8
相关论文
共 50 条
  • [1] Bacteremia in cirrhotic patients with upper gastrointestinal bleeding
    Li, Shuying
    Shen, Haie
    Li, Ji
    Hou, Xiaoli
    Zhang, Ke
    Li, Jintao
    [J]. TURKISH JOURNAL OF GASTROENTEROLOGY, 2018, 29 (02): : 164 - 169
  • [2] Prognostic Value of AIMS65 Score in Cirrhotic Patients with Upper Gastrointestinal Bleeding
    Gaduputi, Vinaya
    Abdulsamad, Molham
    Tariq, Hassan
    Rafeeq, Ahmed
    Abbas, Naeem
    Kumbum, Kavitha
    Chilimuri, Sridhar
    [J]. GASTROENTEROLOGY RESEARCH AND PRACTICE, 2014, 2014
  • [3] Predictive factors in cirrhotic patients with upper gastrointestinal bleeding
    Goldis, A.
    Ratiu, I.
    Diaconescu, R.
    Lazar, D.
    [J]. EUROPEAN JOURNAL OF CLINICAL INVESTIGATION, 2015, 45 : 40 - 41
  • [4] Antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding
    Chavez-Tapia, Norberto C.
    Barrientos-Gutierrez, Tonatiuh
    Tellez-Avila, Felix I.
    Soares-Weiser, Karla
    Uribe, Misael
    [J]. COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2010, (09):
  • [5] Prophylactic Antibiotics in Cirrhotic Patients With Upper Gastrointestinal Bleeding
    Runde, Daniel P.
    [J]. ACADEMIC EMERGENCY MEDICINE, 2021, 28 (01) : 133 - 134
  • [6] Optimising emergency care of upper gastrointestinal bleeding in cirrhotic patients
    Burroughs, AK
    [J]. OPTIMAL MANAGEMENT OF UPPER GASTROINTESTINAL BLEEDING, 1997, 19 (08): : 23 - 31
  • [7] Optimizing emergency care of upper gastrointestinal bleeding in cirrhotic patients
    Burroughs, AK
    Planas, R
    Svoboda, P
    [J]. SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY, 1998, 33 : 14 - 24
  • [8] Antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding: Is evidence adequate?
    Ueno, M.
    Mano, T.
    Kayahara, T.
    Mizuno, M.
    [J]. JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, 2021, 36 (11) : 3249 - 3250
  • [9] Risk factors associated with mortality in upper gastrointestinal bleeding in cirrhotic patients
    Barbulescu, Andra
    Sirli, Roxana
    Ioan, Sporea
    Lupusoru, Raluca
    Danila, Mirela
    Popescu, Alina
    Madalina, Hnatiuc
    Ratiu, Iulia
    [J]. JOURNAL OF HEPATOLOGY, 2020, 73 : S695 - S695
  • [10] MANAGEMENT OF GASTROINTESTINAL BLEEDING IN CIRRHOTIC PATIENTS
    RUEFF, B
    BENHAMOU, JP
    [J]. CLINICS IN GASTROENTEROLOGY, 1975, 4 (02): : 425 - 438