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. 2022 Jul 31;22(1):368.
doi: 10.1186/s12876-022-02448-x.

Nomogram for predicting rebleeding after initial endoscopic epinephrine injection monotherapy hemostasis in patients with peptic ulcer bleeding: a retrospective cohort study

Shan He #  1 , Linlin Liu #  1 , Liu Ouyang  1 , Jingsong Wang  1 , Nonghua Lv  1 , Youxiang Chen  1 , Xu Shu  1 , Zhenhua Zhu  2
Affiliations

Nomogram for predicting rebleeding after initial endoscopic epinephrine injection monotherapy hemostasis in patients with peptic ulcer bleeding: a retrospective cohort study

Shan He et al. BMC Gastroenterol. .

Abstract

Background: Although the current guidelines recommend endoscopic combination therapy, endoscopic epinephrine injection (EI) monotherapy is still a simple, common and effective modality for treating peptic ulcer bleeding (PUB). However, the rebleeding risk after EI monotherapy is still high, and identifying rebleeding patients after EI monotherapy is unclear, which is highly important in clinical practice. This study aimed to identify risk factors and constructed a predictive nomogram related to rebleeding after EI monotherapy.

Methods: We consecutively and retrospectively analyzed 360 PUB patients who underwent EI monotherapy between March 2014 and July 2021 in our center. Then we identified independent risk factors associated with rebleeding after initial endoscopic EI monotherapy by multivariate logistic regression. A predictive nomogram was developed and validated based on the above predictors.

Results: Among all PUB patients enrolled, 51 (14.2%) had recurrent hemorrhage within 30 days after endoscopic EI monotherapy. After multivariate logistic regression, shock [odds ratio (OR) = 12.691, 95% confidence interval (CI) 5.129-31.399, p < 0.001], Rockall score (OR = 1.877, 95% CI 1.250-2.820, p = 0.002), tachycardia (heart rate > 100 beats/min) (OR = 2.610, 95% CI 1.098-6.203, p = 0.030), prolonged prothrombin time (PT > 13 s) (OR = 2.387, 95% CI 1.019-5.588, p = 0.045) and gastric ulcer (OR = 2.258, 95% CI 1.003-5.084, p = 0.049) were associated with an increased risk of rebleeding after an initial EI monotherapy treatment. A nomogram incorporating these independent high-risk factors showed good discrimination, with an area under the receiver operating characteristic curve (AUROC) of 0.876 (95% CI 0.817-0.934) (p < 0.001).

Conclusions: We developed a predictive nomogram of rebleeding after EI monotherapy, which had excellent prediction accuracy. This predictive nomogram can be conveniently used to identify low-risk rebleeding patients after EI monotherapy, allowing for decision-making in a clinical setting.

Keywords: Epinephrine injection monotherapy; Nomogram; Peptic ulcer bleeding; Rebleeding; Risk factors.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Endoscopic findings of standard epinephrine monotherapy in the treatment of PUB patients. A Forrest Ib PUB patients before EI therapy; B Forrest Ib PUB patients after EI therapy; C Forrest IIa PUB patients before EI therapy; D Forrest IIa PUB patients after EI therapy; E Forrest IIb PUB patients before EI therapy; F Forrest IIb PUB patients after EI therapy
Fig. 2
Fig. 2
The Flowchart of patients included in this study
Fig. 3
Fig. 3
Predictive nomogram for recurrent bleeding after single endoscopic epinephrine injection therapy
Fig. 4
Fig. 4
ROC Curve showing the predictive ability for Rebleeding
Fig. 5
Fig. 5
Calibration curves of the nomogram. “Rebleeding status = 1” means “Rebleeding”, “Pr” means “Probability”
Fig. 6
Fig. 6
Algorithm for the management of peptic ulcer bleeding patients according to the predictive Nomogram
See this image and copyright information in PMC

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