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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.
Insights
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.
Background:
Massive postoperative gastrointestinal bleeding is a severe postoperative complication of Crohn's disease (CD) with a high mortality rate, and deteriorating patients' recovery. However, there are few related studies, and it lacks effective prevention measures. Therefore, we conducted a multicenter study to explore the risk factors for massive postoperative gastrointestinal bleeding in CD patients.
Methods:
This study was a multicenter retrospective case-control study. Patients who were diagnosed with CD and underwent gastrointestinal (GI) surgery were enrolled. The control group was matched 1:4 for gender and age. By comparing perioperative medical information between two groups, risk factors were identified through logistic regression analysis. A nomogram was constructed and internal validation was performed by bootstrap resampling.
Results:
A total of 170 patients were included. Multivariable logistic regression revealed the independent predictors of massive postoperative gastrointestinal bleeding involving the number of previous abdominal surgeries (OR = 2.56, 95% CI = 1.54-4.24), GI bleeding history (OR = 6.17, 95% CI = 1.59-23.97), serum albumin (ALB) (OR = 0.88, 95% CI = 0.81-0.96), and Nutrition Risk Screening 2002 (OR = 1.57, 95% CI = 1.08-2.29). The nomogram achieved an area under the curve (AUC) value of 0.85 (95% CI: 0.76-0.93). In internal validation, the AUC value was 0.976 (95% CI: 0.955-0.997). Calibration curves showed good alignment. DCA demonstrated that the diagnostic model had good clinical efficiency.
Conclusion:
The risk of massive postoperative gastrointestinal bleeding in CD patients will be increased with a GI bleeding history, more previous abdominal surgeries, higher nutrition risk, and lower ALB level. Our nomogram model is effective and could be a useful tool for prediction.
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