消化内镜联合血细胞比容对急性非静脉曲张性上消化道出血的预测价值

Prognostic value of gastrointestinal endoscopy combined with hematocrit in acute non-variceal upper gastrointestinal bleeding

  • 摘要: 目的:探讨消化内镜联合血细胞比容(HCT)对急性非静脉曲张性上消化道出血(ANVUGIB)的预测价值。方法:选取2019年8月至2022年8月成都市第七人民医院收治的366例有ANVUGIB风险的患者,根据是否发生ANVUGIB分为ANVUGIB组(100例)和非ANVUGIB组(266例),比较两组临床资料、消化内镜表现、HCT水平,LASSO回归分析筛选影响ANVUGIB 发生情况的相关因素,多因素logistic 回归分析ANVUGIB 的影响因素并建模,R 语言绘制logistic 回归模型的列线图,Bootstrap 法进行内部验证,受试者工作特征曲线(ROC)分析各相关因素与列线图预测ANVUGIB 的价值,决策分析曲线(DCA)验证各相关因素与列线图的临床效用。结果:ANVUGIB组红细胞计数、HCT低于非ANVUGIB组,尿素氮高于非ANVUGIB 组,胃癌、消化性溃疡、血管裸露、血凝块附着患者多于非ANVUGIB 组(P< 0.05);经交叉验证法获取最优解筛选出6个预测变量,logistic回归分析显示,红细胞计数(OR=0.408)、HCT(OR=0.322)、胃癌(OR=6.829)、消化性溃疡(OR=8.771)、血管裸露(OR=9.461)、血凝块附着(OR=9.829)均为ANVUGIB发生的影响因素(P< 0.05)。Logistic回归模型的列线图预测风险能力指数(C-index)为0.962,预测准确度良好,Bootstrap内部验证显示,该预测模型校准度良好;ROC曲线显示,预测ANVUGIB的AUC为0.962,敏感度为80.93%,特异度为96.24%,列线图预测ANVUGIB的AUC大于各相关因素,净获益率均高于各相关因素(P< 0.05)。结论:ANVUGIB的发生受红细胞计数、HCT、胃癌、消化性溃疡、血管裸露、血凝块附着等因素影响,logistic回归模型列线图对ANVUGIB的发生风险有较高的预测价值。

     

    Abstract: Objective:To investigate the prognostic value of gastrointestinal endoscopy combined with hematocrit (HCT) in acute non-variceal upper gastrointestinal bleeding (ANVUGIB).Methods:A total of 366 patients with ANVUGIB risk admitted to Chengdu Seventh People’s Hospital from August 2019 to August 2022 were selected and divided into ANVUGIB group(100 cases)and non-ANVUGIB group(266 cases)according to whether ANVUGIB occurred or not.Clinical data, gastrointestinal endoscopy performance and HCT level between the two groups were compared, and LASSO regression analysis screened the relevant factors affecting the occurrence of ANVUGIB.The influential factors of ANVUGIB were analyzed and modeled by multi-factor logistic regression.The nomogram of the logistic regression model was drawn in R language, Bootstrap method was used for internal validation, receiver operating characteristic(ROC) curve was used to analyze all correlated factors and the value of the nomogram in predicting ANVUGIB, and decision curve analysis(DCA)was used to verify the clinical utility of all correlated factors and nomogram.Results:Red blood cell count and HCT were lower in the ANVUGIB group than in the non-ANVUGIB group, urea nitrogen was higher than that in the non-ANVUGIB group, and the patients with gastric cancer, peptic ulcer, vascular nudity and blood clot adhesion were more than those in the non-ANVUGIB group (P< 0.05).Six predictor variables were screened by cross-validation method to obtain the optimal solution, logistic regression analysis showed that red blood cell count (OR=0.408), HCT(OR=0.322), gastric cancer (OR=6.829), peptic ulcer (OR=8.771), vascular nudity (OR=9.461), and blood clot adhesion (OR=9.829) were all influential factors for the occurrence of ANVUGIB(P< 0.05).The risk capacity index(C-index)of the nomogram of the logistic regression model was 0.962, with good predictive accuracy.Internal validation using Bootstrap showed that the predictive model was well calibrated; ROC curve showed that the AUC for predicting ANVUGIB was 0.962, with a sensitivity of 80.93% and a specificity of 96.24%, and the AUC for predicting ANVUGIB using the nomogram was greater than that of all correlated factors, and the net gain rates were higher than those of all correlated factors(P< 0.05).Conclusion:The occurrence of ANVUGIB is affected by red blood cell count, HCT, gastric cancer, peptic ulcer, vascular nudity, blood clot adhesion, etc.The nomogram of the logistic regression model has high predictive value for the occurrence risk of ANVUGIB.

     

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