Tamotsu Matsuhashi1, Waku Hatta2, Takuto Hikichi3, Sho Fukuda1, Tatsuya Mikami4, Tetsuya Tatsuta5, Jun Nakamura3, Yasuhiko Abe6, Yusuke Onozato7, Yohei Ogata8, Atsushi Masamune8, Motoki Ohyauchi9, Hirotaka Ito9, Norihiro Hanabata10, Yasumitsu Araki10, Takumi Yanagita11, Hidemichi Imamura11, Tsuyotoshi Tsuji12, Kae Sugawara12, Yohei Horikawa13, Shuichi Ohara14, Yutaka Kondo14, Takahiro Dohmen15, Yoichi Kakuta8, Tomohiro Nakamura16, Katsunori Iijima1. 1. Department of Gastroenterology, Akita University Graduate School of Medicine, Akita, Japan. 2. Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan. waku-style@festa.ocn.ne.jp. 3. Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan. 4. Division of Endoscopy, Hirosaki University Hospital, Hirosaki, Japan. 5. Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan. 6. Division of Endoscopy, Yamagata University Hospital, Yamagata, Japan. 7. Department of Gastroenterology, Faculty of Medicine, Yamagata University Hospital, Yamagata, Japan. 8. Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan. 9. Department of Gastroenterology, Osaki Citizen Hospital, Osaki, Japan. 10. Department of Gastroenterology, Aomori Prefectural Central Hospital, Aomori, Japan. 11. Department of Gastroenterology, Ohta Nishinouchi Hospital, Kooriyama, Japan. 12. Department of Gastroenterology, Akita City Hospital, Akita, Japan. 13. Department of Gastroenterology, Hiraka General Hospital, Yokote, Japan. 14. Department of Gastroenterology, Tohoku Rosai Hospital, Sendai, Japan. 15. Department of Gastroenterology, Yuri Kumiai General Hospital, Yurihonjou, Japan. 16. Department of Health Record Informatics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.
Abstract
BACKGROUND: No prediction scores for the mortality of both inpatients and outpatients who developed nonvariceal upper gastrointestinal bleeding (UGIB) without endoscopic findings have been established. We aimed to derive and validate a novel prediction score for in-hospital mortality. METHODS: We conducted a three-stage, multicenter retrospective study. In the derivation stage, patients with nonvariceal UGIB at six institutions were enrolled to derive the prediction score by logistic regression analysis. External validation of the score was performed to analyze discrimination by patients at six other institutions. Then the performance of this score was compared with that of four existing scores. RESULTS: We enrolled 1380 and 825 patients in the derivation and validation cohorts, respectively. A prediction score (CHAMPS-R Score) comprising seven variables (Charlson Comorbidity Index ≥ 2, in-hospital onset, albumin < 2.5 g/dL, altered mental status, Eastern Cooperative Oncology Group performance status ≥ 2, steroids, and rebleeding) with equal-weight scores was established, with high discriminative ability in both derivation and validation cohorts (c statistic, 0.91 and 0.80, respectively). When rebeeding was excluded from the score (an onset model; CHAMPS Score), this score also achieved high discriminative ability (c statistic, 0.90 and 0.81, respectively). The prediction scores had significantly higher discriminative ability than the Glasgow Blatchford Score, AIMS65, ABC Score, and clinical Rockall Score in both cohorts (all, p < 0.05). CONCLUSIONS: We derived and externally validated prediction scores for in-hospital mortality in patients with nonvariceal UGIB. The CHAMPS Score might be optimal for managing such patients. Its mobile application is freely available ( https://apps.apple.com/app/id1565716902 for iOS and https://play.google.com/store/apps/details?id=hatta.CHAMPS for Android).
BACKGROUND: No prediction scores for the mortality of both inpatients and outpatients who developed nonvariceal upper gastrointestinal bleeding (UGIB) without endoscopic findings have been established. We aimed to derive and validate a novel prediction score for in-hospital mortality. METHODS: We conducted a three-stage, multicenter retrospective study. In the derivation stage, patients with nonvariceal UGIB at six institutions were enrolled to derive the prediction score by logistic regression analysis. External validation of the score was performed to analyze discrimination by patients at six other institutions. Then the performance of this score was compared with that of four existing scores. RESULTS: We enrolled 1380 and 825 patients in the derivation and validation cohorts, respectively. A prediction score (CHAMPS-R Score) comprising seven variables (Charlson Comorbidity Index ≥ 2, in-hospital onset, albumin < 2.5 g/dL, altered mental status, Eastern Cooperative Oncology Group performance status ≥ 2, steroids, and rebleeding) with equal-weight scores was established, with high discriminative ability in both derivation and validation cohorts (c statistic, 0.91 and 0.80, respectively). When rebeeding was excluded from the score (an onset model; CHAMPS Score), this score also achieved high discriminative ability (c statistic, 0.90 and 0.81, respectively). The prediction scores had significantly higher discriminative ability than the Glasgow Blatchford Score, AIMS65, ABC Score, and clinical Rockall Score in both cohorts (all, p < 0.05). CONCLUSIONS: We derived and externally validated prediction scores for in-hospital mortality in patients with nonvariceal UGIB. The CHAMPS Score might be optimal for managing such patients. Its mobile application is freely available ( https://apps.apple.com/app/id1565716902 for iOS and https://play.google.com/store/apps/details?id=hatta.CHAMPS for Android).