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

doi:10.4240/wjgs.v16.i3.790

MH-STRALP: A scoring system for prognostication in patients with upper gastrointestinal bleeding

World J Gastrointest Surg. 2024 Mar 27;16(3):790-806. doi: 10.4240/wjgs.v16.i3.790.

Authors

Jun-Nan Hu¹, Fei Xu¹, Ya-Rong Hao², Chun-Yan Sun¹, Kai-Ming Wu², Yong Lin², Lan Zhong¹, Xin Zeng³

Affiliations

¹ Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China.
² Department of Gastroenterology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai 200003, China.
³ Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China. zengxinmd1978@163.com.

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