Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2024; 16(3): 790-806
Published online Mar 27, 2024. doi: 10.4240/wjgs.v16.i3.790
MH-STRALP: A scoring system for prognostication in patients with upper gastrointestinal bleeding
Jun-Nan Hu, Fei Xu, Ya-Rong Hao, Chun-Yan Sun, Kai-Ming Wu, Yong Lin, Lan Zhong, Xin Zeng
Jun-Nan Hu, Fei Xu, Chun-Yan Sun, Lan Zhong, Xin Zeng, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
Ya-Rong Hao, Kai-Ming Wu, Yong Lin, Department of Gastroenterology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai 200003, China
Co-first authors: Jun-Nan Hu and Fei Xu.
Co-corresponding authors: Lan Zhong and Xin Zeng.
Author contributions: Hu JN, Xu F were involved in investigation, acquisition, data collection, and drafting of the manuscript; Sun CY, Wu KM were involved in analysis of data; Hao YR was involved in investigation, acquisition, data collection; Lin Y was involved in concept and design, gathering conflict-of-interest forms and statements, are properly completed; Zhong L, Zeng X were involved in providing details of authorship, acquisition and interpretation of funding, ethics committee approval documentation, review and edit the manuscript. All authors were involved in the critical review of the results and have contributed to, read, and approved the final manuscript. Hu JN and Xu F contributed equally to this work as co-first authors. The reasons for designating Hu JN and Xu F as co-first authors are as follows. They have equally contributed to the project by leading and executing a critical component of the research, namely developing the computational model, solving pivotal theoretical problems. They also shared equal responsibility in the process of writing, editing, and refining the manuscript, as well as preparing the visualizations that greatly enhance the clarity and impact of the work. Zhong L and Zeng X contributed equally to this work as co-corresponding authors. The reasons for designating Zhong L and Zeng X as co-corresponding authors are as follows. Zhong L and Zeng X played a crucial role in providing author details, acquiring and interpreting funding, obtaining ethics committee approval documents, and revising and editing the manuscript. The contributions of both authors were essential for the smooth progress of the research and the writing of the final paper, reflecting their significant leadership and coordination role throughout the research process. Their expertise and contributions were indispensable in ensuring the quality and integrity of the study. By involving themselves in every key stage of the project and bearing the responsibility of ensuring the research adhered to ethical and funding body standards, the designation of co-corresponding authors serves as recognition of their significant work. Moreover, they ensured that the paper had proper technical and administrative support during the submission process and after publication, guaranteeing high standards and transparency for the research and manuscript. Therefore, appointing Zhong L and Zeng X as co-corresponding authors is a fair and appropriate reflection of their substantial contributions and corresponding responsibilities to this research. This research was completed as a result of collaborative teamwork, and designating co-first authors and co-corresponding authors accurately reflects the distribution of responsibility and the burden of time and effort required to complete the study and the manuscript. It also embodies our team’s spirit of collaboration, the equitable contributions, and the diversity present within our group.
Supported by Key Disciplines Group Construction Project of Shanghai Pudong New Area Health Commission, No. PWZxq2022-06; Medical discipline Construction Project of Pudong Health Committee of Shanghai, No. PWYgf2021-02; Joint Tackling Project of Pudong Health Committee of Shanghai, No. PW2022D08; and the Medical Innovation Research Project of the Shanghai Science and Technology Commission, No. 22Y11908400.
Institutional review board statement: The study protocol was reviewed and approved by the Institutional Ethics Committee of Shanghai East Hospital (Approval No. 2020SL018).
Informed consent statement: Given this article is a retrospective study, an informed consent form is not included.
Conflict-of-interest statement: Dr. Zeng has nothing to disclose.
Data sharing statement: The data supporting the findings of this study are available from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xin Zeng, MD, PhD, Chief Doctor, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, No. 150 Jimo Road, Shanghai 200120, China. zengxinmd1978@163.com
Received: December 22, 2023
Peer-review started: December 22, 2023
First decision: January 9, 2024
Revised: January 21, 2024
Accepted: February 29, 2024
Article in press: February 29, 2024
Published online: March 27, 2024
Processing time: 90 Days and 21.6 Hours
Abstract
BACKGROUND

Upper gastrointestinal bleeding (UGIB) is a common medical emergency and early assessment of its outcomes is vital for treatment decisions.

AIM

To develop a new scoring system to predict its prognosis.

METHODS

In this retrospective study, 692 patients with UGIB were enrolled from two centers and divided into a training (n = 591) and a validation cohort (n = 101). The clinical data were collected to develop new prognostic prediction models. The endpoint was compound outcome defined as (1) demand for emergency surgery or vascular intervention, (2) being transferred to the intensive care unit, or (3) death during hospitalization. The models’ predictive ability was compared with previously established scores by receiver operating characteristic (ROC) curves.

RESULTS

Totally 22.2% (131/591) patients in the training cohort and 22.8% (23/101) in the validation cohort presented poor outcomes. Based on the stepwise-forward Logistic regression analysis, eight predictors were integrated to determine a new post-endoscopic prognostic scoring system (MH-STRALP); a nomogram was determined to present the model. Compared with the previous scores (GBS, Rockall, ABC, AIMS65, and PNED score), MH-STRALP showed the best prognostic prediction ability with area under the ROC curves (AUROCs) of 0.899 and 0.826 in the training and validation cohorts, respectively. According to the calibration curve, decision curve analysis, and internal cross-validation, the nomogram showed good calibration ability and net clinical benefit in both cohorts. After removing the endoscopic indicators, the pre-endoscopic model (pre-MH-STRALP score) was conducted. Similarly, the pre-MH-STRALP score showed better predictive value (AUROCs of 0.868 and 0.767 in the training and validation cohorts, respectively) than the other pre-endoscopic scores.

CONCLUSION

The MH-STRALP score and pre-MH-STRALP score are simple, convenient, and accurate tools for prognosis prediction of UGIB, and may be applied for early decision on its management strategies.

Keywords: Upper gastrointestinal bleeding; Prognosis prediction; Retrospective study; Nomogram; Post-endoscopic model; Pre-endoscopic model

Core Tip: This study carried out a retrospective study to develop new scoring systems to predict the prognosis of upper gastrointestinal bleeding (UGIB). The patients with UGIB in two centers were enrolled into a training cohort (n = 591) and a validation cohort (n = 101). A new post-endoscopic prognostic scoring system (MH-STRALP) and a pre-endoscopic model were conducted and determined with nomograms. The two scores showed better predictive value in both training cohort and validation cohort than the other scores. Thus, we believe that we provided simple, convenient, and accurate tools for UGIB prognostication and early decision on the management strategies.