New predictive model of rebleeding during follow-up of patents with obscure gastrointestinal bleeding: A multicenter cohort study.

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.

• Authors: Ryota Niikura, Atsuo Yamada, Naoyoshi Nagata, Yuka Kobayashi, Makoto Okamoto, Yuzo Mitsuno, Keiji Ogura, Shuntaro Yoshida, Takuro Shimbo, Yoshihiro Hirata, Kazuhiko Koike
• Journal: Journal of gastroenterology and hepatology (J Gastroenterol Hepatol) Vol. 31 Issue 4 Pg. 752-60 (Apr 2016) ISSN: 1440-1746 [Electronic] Australia
• PMID: 26487158 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2015 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

Topics

• Aged
• Blood Transfusion (statistics & numerical data)
• Capsule Endoscopy
• Cohort Studies
• Databases as Topic
• Female
• Follow-Up Studies
• Forecasting
• Gastrointestinal Hemorrhage (diagnostic imaging, epidemiology, mortality, therapy)
• Humans
• Incidence
• Length of Stay (statistics & numerical data)
• Male
• Middle Aged
• Models, Statistical
• Multicenter Studies as Topic
• Proportional Hazards Models
• Recurrence
• Retrospective Studies
• Time Factors