A novel prediction tool for mortality in patients with acute lower gastrointestinal bleeding requiring emergency hospitalization: a large multicenter study

被引：1

作者：

Tominaga, Naoyuki ^{[1
]}

Sadashima, Eiji ^{[2
]}

Aoki, Tomonori ^{[3
]}

Fujita, Minoru ^{[4
]}

Kobayashi, Katsumasa ^{[5
]}

Yamauchi, Atsushi ^{[6
]}

Yamada, Atsuo ^{[3
]}

Omori, Jun ^{[7
]}

Ikeya, Takashi ^{[8
]}

Aoyama, Taiki ^{[9
]}

Sato, Yoshinori ^{[10
]}

Kishino, Takaaki ^{[11
]}

Ishii, Naoki ^{[12
]}

Sawada, Tsunaki ^{[13
]}

Murata, Masaki ^{[14
]}

Takao, Akinari ^{[15
]}

Mizukami, Kazuhiro ^{[16
]}

Kinjo, Ken ^{[17
]}

Fujimori, Shunji ^{[18
]}

Uotani, Takahiro ^{[19
]}

Sato, Hiroki ^{[20
]}

Suzuki, Sho ^{[21
,22
]}

Narasaka, Toshiaki ^{[23
,24
]}

Hayasaka, Junnosuke ^{[25
]}

Funabiki, Tomohiro ^{[26
,27
]}

Kinjo, Yuzuru ^{[28
]}

Mizuki, Akira ^{[29
]}

Kiyotoki, Shu ^{[30
]}

Mikami, Tatsuya ^{[31
]}

Gushima, Ryosuke ^{[32
]}

Fujii, Hiroyuki ^{[33
]}

Fuyuno, Yuta ^{[34
]}

Hikichi, Takuto ^{[35
]}

Toya, Yosuke ^{[36
]}

Narimatsu, Kazuyuki ^{[37
]}

Manabe, Noriaki ^{[38
]}

Nagaike, Koji ^{[39
]}

Kinjo, Tetsu ^{[40
]}

Sumida, Yorinobu ^{[41
]}

Funakoshi, Sadahiro ^{[42
]}

Kobayashi, Kiyonori ^{[43
]}

Matsuhashi, Tamotsu ^{[44
]}

Komaki, Yuga ^{[45
]}

Miki, Kuniko ^{[46
]}

Watanabe, Kazuhiro ^{[47
]}

Kaise, Mitsuru ^{[7
]}

Nagata, Naoyoshi ^{[46
,47
]}

机构：

[1] Saga Ken Med Ctr Koseikan, Dept Gastroenterol, 400 Nakabaru, Kasemachi, Saga 8408571, Japan

[2] Saga Ken Med Ctr Koseikan, Dept Med Res Inst, Saga, Japan

[3] Univ Tokyo, Grad Sch Med, Dept Gastroenterol, Tokyo, Japan

[4] Kawasaki Med Sch, Gen Med Ctr, Div Endoscopy & Ultrasonog, Dept Clin Pathol & Lab Med, Okayama, Japan

[5] Tokyo Metropolitan Bokutoh Hosp, Dept Gastroenterol, Tokyo, Japan

[6] Kitano Hosp, Tazuke Kofukai Med Res Inst, Dept Gastroenterol & Hepatol, Osaka, Japan

[7] Nippon Med Sch, Grad Sch Med, Dept Gastroenterol, Tokyo, Japan

[8] St Lukes Int Univ, Dept Gastroenterol, Tokyo, Japan

[9] Hiroshima City Asa Citizens Hosp, Dept Gastroenterol, Hiroshima, Japan

[10] St Marianna Univ, Sch Med, Div Gastroenterol & Hepatol, Dept Internal Med, Yokohama, Kanagawa, Japan

[11] Nara City Hosp, Ctr Digest & Liver Dis, Dept Gastroenterol & Hepatol, Nara, Japan

[12] Tokyo Shinagawa Hosp, Dept Gastroenterol, Tokyo, Japan

[13] Nagoya Univ Hosp, Dept Endoscopy, Nagoya, Aichi, Japan

[14] Natl Hosp Org Kyoto Med Ctr, Dept Gastroenterol, Kyoto, Japan

[15] Komagome Hosp, Tokyo Metropolitan Canc & Infect Dis Ctr, Dept Gastroenterol, Tokyo, Japan

[16] Oita Univ, Dept Gastroenterol, Oita, Japan

[17] Fukuoka Univ, Chikushi Hosp, Dept Gastroenterol, Fukuoka, Japan

[18] Chiba Hokusoh Hosp, Nippon Med Sch, Dept Gastroenterol, Chiba, Japan

[19] Japanese Red Cross Shizuoka Hosp, Dept Gastroenterol, Shizuoka, Japan

[20] Niigata Univ, Grad Sch Med & Dent Sci, Div Gastroenterol, Niigata, Japan

[21] Univ Miyazaki Hosp, Ctr Digest Dis, Dept Gastroenterol & Hepatol, Miyazaki, Japan

[22] Univ Miyazaki Hosp, Div Endoscopy, Miyazaki, Japan

[23] Univ Tsukuba, Dept Gastroenterol, Ibaraki, Japan

[24] Univ Tsukuba Hosp, Div Endoscop Ctr, Ibaraki, Japan

[25] Toranomon Gen Hosp, Dept Gastroenterol, Tokyo, Japan

[26] Saiseikai Yokohamashi Tobu Hosp, Emergency & Crit Care Ctr, Yokohama, Kanagawa, Japan

[27] Fujita Hlth Univ Hosp, Dept Emergency Med, Toyoake, Aichi, Japan

[28] Naha City Hosp, Dept Gastroenterol, Okinawa, Japan

[29] Tokyo Saiseikai Cent Hosp, Dept Internal Med, Tokyo, Japan

[30] Shuto Gen Hosp, Dept Gastroenterol, Yamaguchi, Japan

[31] Hirosaki Univ Hosp, Div Endoscopy, Aomori, Japan

[32] Kumamoto Univ, Grad Sch Med Sci, Dept Gastroenterol & Hepatol, Kumamoto, Japan

[33] Natl Hosp Org Fukuokahigashi Med Ctr, Dept Gastroenterol & Hepatol, Fukuoka, Japan

[34] Kyushu Univ, Grad Sch Med Sci, Dept Med & Clin Sci, Fukuoka, Japan

[35] Fukushima Med Univ Hosp, Dept Endoscopy, Fukushima, Japan

[36] Iwate Med Univ, Dept Internal Med, Div Gastroenterol, Iwate, Japan

[37] Natl Def Med Coll, Dept Internal Med, Saitama, Japan

[38] Kawasaki Med Sch, Dept Clin Pathol & Lab Med, Div Endoscopy & Ultrasonog, Okayama, Japan

[39] Suita Municipal Hosp, Dept Gastroenterol & Hepatol, Osaka, Japan

[40] Univ Ryukyus Hosp, Dept Endoscopy, Okinawa, Japan

[41] Natl Hosp Org Kyushu Med Ctr, Dept Gastroenterol, Fukuoka, Japan

[42] Fukuoka Univ Hosp, Dept Gastroenterol Endoscopy, Fukuoka, Japan

[43] Kitasato Univ, Sch Med, Dept Gastroenterol, Kanagawa, Japan

[44] Akita Univ, Grad Sch Med, Dept Gastroenterol & Neurol, Akita, Japan

[45] Kagoshima Univ, Grad Sch Med & Dent Sci, Digest & Lifestyle Dis, Kagoshima, Japan

[46] Tokyo Med Univ, Dept Gastroenterol Endoscopy, Tokyo, Japan

[47] Natl Ctr Global Hlth & Med, Dept Gastroenterol & Hepatol, Tokyo, Japan

来源：

SCIENTIFIC REPORTS | 2024年 / 14卷 / 01期

关键词：

LOGISTIC-REGRESSION; EARLY COLONOSCOPY; PROPENSITY SCORE; RISK; CACHEXIA; VALIDATION; MANAGEMENT; DIAGNOSIS; PROGNOSIS; OUTCOMES;

D O I：

10.1038/s41598-024-55889-7

中图分类号：

O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

The study aimed to identify prognostic factors for patients with acute lower gastrointestinal bleeding and to develop a high-accuracy prediction tool. The analysis included 8254 cases of acute hematochezia patients who were admitted urgently based on the judgment of emergency physicians or gastroenterology consultants (from the CODE BLUE J-study). Patients were randomly assigned to a derivation cohort and a validation cohort in a 2:1 ratio using a random number table. Assuming that factors present at the time of admission are involved in mortality within 30 days of admission, and adding management factors during hospitalization to the factors at the time of admission for mortality within 1 year, prognostic factors were established. Multivariate analysis was conducted, and scores were assigned to each factor using regression coefficients, summing these to measure the score. The newly created score (CACHEXIA score) became a tool capable of measuring both mortality within 30 days (ROC-AUC 0.93) and within 1 year (C-index, 0.88). The 1-year mortality rates for patients classified as low, medium, and high risk by the CACHEXIA score were 1.0%, 13.4%, and 54.3% respectively (all P < 0.001). After discharge, patients identified as high risk using our unique predictive score require ongoing observation.

引用

页数：14

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