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- Title
New predictive model of rebleeding during follow-up of patents with obscure gastrointestinal bleeding: A multicenter cohort study.
- Authors
Niikura, Ryota; Yamada, Atsuo; Nagata, Naoyoshi; Kobayashi, Yuka; Okamoto, Makoto; Mitsuno, Yuzo; Ogura, Keiji; Yoshida, Shuntaro; Shimbo, Takuro; Hirata, Yoshihiro; Koike, Kazuhiko
- Abstract
Background and Aim: The long-term recurrence rate of patients with obscure gastrointestinal bleeding (OGIB) who underwent video capsule endoscopy (VCE) remains unknown. Our study aimed to identify the cumulative incidence of rebleeding, develop a predictive model of rebleeding, and evaluate whether the model can be applied in other outcomes among patients with OGIB. Methods: We conducted a multicenter retrospective cohort study of 320 patients with OGIB who underwent VCE between 2009 and 2014. A rebleeding model was developed using multivariate Cox proportional hazards analysis and evaluated using Harrell's c-index. Results: Rebleeding occurred in 43 patients (13.4%) during a mean follow-up period of 18.3 (standard error, 0.9) months. The rebleeding sources were the small intestine ( n = 17), extra-small intestine ( n = 13), and unknown ( n = 13). The cumulative incidence of rebleeding was 11.0% at 12 months and 35.3% at 60 months. Multivariate analysis revealed that female gender, liver cirrhosis, warfarin use, overt bleeding, and positive VCE findings were significant predictors of rebleeding. The rebleeding rate was 0% in patients with no predictors and 40% in patients with full predictors ( P < 0.01). The model presented a high predictive accuracy ( c-statistic, 0.733). Patients with higher predictors exhibited higher transfusion requirements, longer length of stay, and higher mortality ( P < 0.01). Conclusion: The cumulative incidence of rebleeding at 12 and 60 months was 11.0% and 35.3%, respectively. Five factors enable prediction of not only rebleeding but also transfusion requirements, length of stay, and death in OGIB patients.
- Subjects
GASTROINTESTINAL hemorrhage diagnosis; GASTROINTESTINAL hemorrhage treatment; CAPSULE endoscopy; DISEASE relapse; PREDICTION models; DISEASE incidence
- Publication
Journal of Gastroenterology & Hepatology, 2016, Vol 31, Issue 4, p752
- ISSN
0815-9319
- Publication type
Article
- DOI
10.1111/jgh.13201