Scientific Reports (Mar 2024)
A novel prediction tool for mortality in patients with acute lower gastrointestinal bleeding requiring emergency hospitalization: a large multicenter study
- Naoyuki Tominaga,
- Eiji Sadashima,
- Tomonori Aoki,
- Minoru Fujita,
- Katsumasa Kobayashi,
- Atsushi Yamauchi,
- Atsuo Yamada,
- Jun Omori,
- Takashi Ikeya,
- Taiki Aoyama,
- Yoshinori Sato,
- Takaaki Kishino,
- Naoki Ishii,
- Tsunaki Sawada,
- Masaki Murata,
- Akinari Takao,
- Kazuhiro Mizukami,
- Ken Kinjo,
- Shunji Fujimori,
- Takahiro Uotani,
- Hiroki Sato,
- Sho Suzuki,
- Toshiaki Narasaka,
- Junnosuke Hayasaka,
- Tomohiro Funabiki,
- Yuzuru Kinjo,
- Akira Mizuki,
- Shu Kiyotoki,
- Tatsuya Mikami,
- Ryosuke Gushima,
- Hiroyuki Fujii,
- Yuta Fuyuno,
- Takuto Hikichi,
- Yosuke Toya,
- Kazuyuki Narimatsu,
- Noriaki Manabe,
- Koji Nagaike,
- Tetsu Kinjo,
- Yorinobu Sumida,
- Sadahiro Funakoshi,
- Kiyonori Kobayashi,
- Tamotsu Matsuhashi,
- Yuga Komaki,
- Kuniko Miki,
- Kazuhiro Watanabe,
- Mitsuru Kaise,
- Naoyoshi Nagata
Affiliations
- Naoyuki Tominaga
- Department of Gastroenterology, Saga-Ken Medical Centre Koseikan
- Eiji Sadashima
- Department of Medical Research Institute, Saga-Ken Medical Centre Koseikan
- Tomonori Aoki
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo
- Minoru Fujita
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center
- Katsumasa Kobayashi
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital
- Atsushi Yamauchi
- Department of Gastroenterology and Hepatology, Kitano Hospital, Tazuke Kofukai Medical Research Institute
- Atsuo Yamada
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo
- Jun Omori
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine
- Takashi Ikeya
- Department of Gastroenterology, St. Luke’s International University
- Taiki Aoyama
- Department of Gastroenterology, Hiroshima City Asa Citizens Hospital
- Yoshinori Sato
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine
- Takaaki Kishino
- Department of Gastroenterology and Hepatology, Center for Digestive and Liver Diseases, Nara City Hospital
- Naoki Ishii
- Department of Gastroenterology, Tokyo Shinagawa Hospital
- Tsunaki Sawada
- Department of Endoscopy, Nagoya University Hospital
- Masaki Murata
- Department of Gastroenterology, National Hospital Organization Kyoto Medical Center
- Akinari Takao
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital
- Kazuhiro Mizukami
- Department of Gastroenterology, Oita University
- Ken Kinjo
- Department of Gastroenterology, Chikushi Hospital, Fukuoka University
- Shunji Fujimori
- Department of Gastroenterology, Nippon Medical School, Chiba Hokusoh Hospital
- Takahiro Uotani
- Department of Gastroenterology, Japanese Red Cross Shizuoka Hospital
- Hiroki Sato
- Division of Gastroenterology, Graduate School of Medical and Dental Sciences, Niigata University
- Sho Suzuki
- Department of Gastroenterology and Hepatology, Center for Digestive Disease and Division of Endoscopy, University of Miyazaki Hospital
- Toshiaki Narasaka
- Department of Gastroenterology, University of Tsukuba
- Junnosuke Hayasaka
- Department of Gastroenterology, Toranomon Hospital
- Tomohiro Funabiki
- Emergency and Critical Care Center, Saiseikai Yokohamashi Tobu Hospital
- Yuzuru Kinjo
- Department of Gastroenterology, Naha City Hospital
- Akira Mizuki
- Department of Internal Medicine, Tokyo Saiseikai Central Hospital
- Shu Kiyotoki
- Department of Gastroenterology, Shuto General Hospital
- Tatsuya Mikami
- Division of Endoscopy, Hirosaki University Hospital
- Ryosuke Gushima
- Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University
- Hiroyuki Fujii
- Department of Gastroenterology and Hepatology, National Hospital Organization Fukuokahigashi Medical Center
- Yuta Fuyuno
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
- Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital
- Yosuke Toya
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University
- Kazuyuki Narimatsu
- Department of Internal Medicine, National Defense Medical College
- Noriaki Manabe
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School
- Koji Nagaike
- Department of Gastroenterology and Hepatology, Suita Municipal Hospital
- Tetsu Kinjo
- Department of Endoscopy, University of the Ryukyus Hospital
- Yorinobu Sumida
- Department of Gastroenterology, National Hospital Organization Kyushu Medical Center
- Sadahiro Funakoshi
- Department of Gastroenterological Endoscopy, Fukuoka University Hospital
- Kiyonori Kobayashi
- Department of Gastroenterology, School of Medicine, Kitasato University
- Tamotsu Matsuhashi
- Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine
- Yuga Komaki
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences
- Kuniko Miki
- Department of Gastroenterological Endoscopy, Tokyo Medical University
- Kazuhiro Watanabe
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine
- Mitsuru Kaise
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine
- Naoyoshi Nagata
- Department of Gastroenterological Endoscopy, Tokyo Medical University
- DOI
- https://doi.org/10.1038/s41598-024-55889-7
- Journal volume & issue
-
Vol. 14,
no. 1
pp. 1 – 14
Abstract
Abstract The study aimed to identify prognostic factors for patients with acute lower gastrointestinal bleeding and to develop a high-accuracy prediction tool. The analysis included 8254 cases of acute hematochezia patients who were admitted urgently based on the judgment of emergency physicians or gastroenterology consultants (from the CODE BLUE J-study). Patients were randomly assigned to a derivation cohort and a validation cohort in a 2:1 ratio using a random number table. Assuming that factors present at the time of admission are involved in mortality within 30 days of admission, and adding management factors during hospitalization to the factors at the time of admission for mortality within 1 year, prognostic factors were established. Multivariate analysis was conducted, and scores were assigned to each factor using regression coefficients, summing these to measure the score. The newly created score (CACHEXIA score) became a tool capable of measuring both mortality within 30 days (ROC-AUC 0.93) and within 1 year (C-index, 0.88). The 1-year mortality rates for patients classified as low, medium, and high risk by the CACHEXIA score were 1.0%, 13.4%, and 54.3% respectively (all P < 0.001). After discharge, patients identified as high risk using our unique predictive score require ongoing observation.
