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Gastrointestinal bleeding in patients admitted to cardiology: risk factors and a new risk score
Ming Zhang1, Demin Liu1, Qian Wang1
1Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China.
Insights
A new risk score accurately predicts gastrointestinal bleeding (GIB) in cardiology patients. This model identifies key risk factors like male sex, heart disease, and hypertension, improving patient care.
Area of Science:
- Cardiology
- Gastroenterology
- Clinical Risk Prediction
Background:
- Gastrointestinal bleeding (GIB) is a significant concern in hospitalized patients.
- Existing risk stratification scores lack specificity for cardiology inpatients.
- There is a need for a tailored risk assessment tool for GIB in this population.
Purpose of the Study:
- To identify risk factors for GIB in cardiology inpatients.
- To develop and validate a novel risk score model for predicting GIB in this specific patient group.
Main Methods:
- A retrospective study included 633 GIB patients and 4,231 controls.
- Multivariate logistic regression identified significant risk factors.
- A new risk score was developed and validated using the area under the receiver operating characteristic (AUROC) curve.
Main Results:
- Key predictors of GIB included male sex, coronary heart disease, hypertension, stroke, systolic blood pressure, hematocrit, plasma albumin, and alanine aminotransferase (ALT).
- The developed model demonstrated high predictive accuracy (AUROC 0.816, validation AUROC 0.841).
- The new score outperformed the HAS-BLED and CRUSADE scores in predicting GIB.
Conclusions:
- Male sex, cardiovascular conditions, and specific laboratory/clinical parameters are significant risk factors for GIB in cardiology patients.
- The novel risk score provides accurate GIB prediction for cardiology inpatients.
- The score effectively stratifies risk, correlating with transfusion needs, length of stay, and mortality.
Objective:
Although the early use of a risk stratification score in gastrointestinal bleeding (GIB) is recommended, so far there has been no risk score for GIB in patients admitted to the cardiology department. To describe the risk factors of GIB and develop a new risk score model in patients admitted to the cardiology department.
Methods:
A total of 633 inpatients with GIB from January 2014 to December 2018 were recruited, 4,231 inpatients with non-GIB were recruited as the control group. Multivariate logistic regression was used to describe the risk factors of GIB. A new risk score model was developed in the derivation cohort. Accuracy to predict GIB was assessed by the area under the receiver operating characteristic (AUROC) curve in the validation cohort.
Results:
Male, coronary heart disease, hypertension, stroke, systolic blood pressure, hematocrit, plasma albumin, and alanine aminotransferase (ALT) were associated with GIB. The model had a high predictive accuracy (AUROC 0.816 and 95% CI, 0.792-0.839), which was supported by the validation cohort (AUROC 0.841 and 95% CI, 0.807~0.874). Besides, the prediction of the model was better than HAS-BLED score (AUROC 0.557; 95% CI, 0.513~0.602) and CRUSADE score (AUROC 0.791; 95%CI, 0.757~0.825), respectively. Among the inpatients with a score of 0-3, 4-7, and ≥8 points, the incidence of GIB, the proportion of inpatients requiring suspended red blood cells transfusion, length of stay, and in-hospital mortality all increased gradually (P< 0.001).
Conclusions:
Male, coronary heart disease, hypertension, stroke, systolic blood pressure, hematocrit, plasma albumin, and ALT are associated with GIB. The new risk score model is an accurate risk score that predicts GIB in patients admitted to the cardiology department.
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