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Risk factor analysis and nomogram for predicting massive postoperative gastrointestinal bleeding in patients with
Mengyi Zhang1, Danhua Yao1, Yuhua Huang1
1Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Massive gastrointestinal bleeding after Crohn's disease surgery is risky. Factors like prior surgeries, bleeding history, and low albumin increase risk, but a new nomogram can predict it.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Oncology
- Clinical Risk Prediction
Background:
- Massive postoperative gastrointestinal bleeding is a severe complication in Crohn's disease (CD) patients, associated with high mortality and impaired recovery.
- Effective prevention strategies are lacking, highlighting the need for better risk identification.
- This multicenter study addresses the gap in understanding risk factors for this critical postoperative event in CD.
Purpose of the Study:
- To identify independent risk factors for massive postoperative gastrointestinal bleeding in patients with Crohn's disease.
- To develop and validate a predictive nomogram model for this complication.
Main Methods:
- A multicenter retrospective case-control study involving 170 patients with Crohn's disease who underwent gastrointestinal surgery.
- Logistic regression analysis was used to identify independent predictors of massive postoperative gastrointestinal bleeding.
- A nomogram was constructed and internally validated using bootstrap resampling and decision curve analysis (DCA).
Main Results:
- Independent predictors identified include: number of previous abdominal surgeries (OR=2.56), history of gastrointestinal bleeding (OR=6.17), serum albumin (ALB) level (OR=0.88), and Nutrition Risk Screening 2002 score (OR=1.57).
- The developed nomogram demonstrated strong predictive performance with an AUC of 0.85 (internal validation AUC=0.976).
- Calibration curves and DCA confirmed the model's good alignment and clinical utility.
Conclusions:
- Increased risk of massive postoperative gastrointestinal bleeding in Crohn's disease patients is associated with a history of GI bleeding, multiple prior abdominal surgeries, elevated nutritional risk, and lower serum albumin levels.
- The developed nomogram serves as an effective tool for predicting massive postoperative gastrointestinal bleeding in this patient population.
- This predictive model can aid in clinical decision-making and potentially improve patient outcomes.
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