MH-STRALP:A scoring system for prognostication in patients with upper gastrointestinal bleeding  

作　　者：Jun-Nan Hu Fei Xu Ya-Rong Hao Chun-Yan Sun Kai-Ming Wu Yong Lin Lan Zhong Xin Zeng 

机构地区：[1]Department of Gastroenterology,Shanghai East Hospital,Tongji University School of Medicine,Shanghai 200120,China [2]Department of Gastroenterology,Shanghai Changzheng Hospital,Navy Military Medical University,Shanghai 200003,China

出　　处：《World Journal of Gastrointestinal Surgery》2024年第3期790-806,共17页世界胃肠外科杂志（英文版）（电子版）

基　　金：Supported by Key Disciplines Group Construction Project of Shanghai Pudong New Area Health Commission,No.PWZxq2022-06;Medical discipline Construction Project of Pudong Health Committee of Shanghai,No.PWYgf2021-02;Joint Tackling Project of Pudong Health Committee of Shanghai,No.PW2022D08;the Medical Innovation Research Project of the Shanghai Science and Technology Commission,No.22Y11908400.

摘　　要：BACKGROUND Upper gastrointestinal bleeding(UGIB)is a common medical emergency and early assessment of its outcomes is vital for treatment decisions.AIM To develop a new scoring system to predict its prognosis.METHODS In this retrospective study,692 patients with UGIB were enrolled from two cen-ters and divided into a training(n=591)and a validation cohort(n=101).The clinical data were collected to develop new prognostic prediction models.The en-dpoint was compound outcome defined as(1)demand for emergency surgery or vascular intervention,(2)being transferred to the intensive care unit,or(3)death during hos-pitalization.The models’predictive ability was compared with previously esta-blished scores by receiver operating characteristic(ROC)curves.RESULTS Totally 22.2%(131/591)patients in the training cohort and 22.8%(23/101)in the validation cohort presented poor outcomes.Based on the stepwise-forward Lo-gistic regression analysis,eight predictors were integrated to determine a new post-endoscopic prognostic scoring system(MH-STRALP);a nomogram was de-termined to present the model.Compared with the previous scores(GBS,Rock-all,ABC,AIMS65,and PNED score),MH-STRALP showed the best prognostic prediction ability with area under the ROC curves(AUROCs)of 0.899 and 0.826 in the training and validation cohorts,respectively.According to the calibration cur-ve,decision curve analysis,and internal cross-validation,the nomogram showed good calibration ability and net clinical benefit in both cohorts.After removing the endoscopic indicators,the pre-endoscopic model(pre-MH-STRALP score)was conducted.Similarly,the pre-MHSTRALP score showed better predictive value(AUROCs of 0.868 and 0.767 in the training and validation cohorts,respectively)than the other pre-endoscopic scores.CONCLUSION The MH-STRALP score and pre-MH-STRALP score are simple,convenient,and accurate tools for prognosis prediction of UGIB,and may be applied for early decision on its management strategies.

关 键 词：Upper gastrointestinal bleeding Prognosis prediction Retrospective study NOMOGRAM Post-endoscopic model Pre-endoscopic model 

分 类 号：R459.7[医药卫生—急诊医学] R735[医药卫生—治疗学]