title: Risk score to predict gastrointestinal bleeding after acute ischemic stroke.
abstract: BACKGROUND
  Gastrointestinal bleeding (GIB) is a common and often serious complication after stroke. Although several risk factors for post-stroke GIB have been identified, no reliable or validated scoring system is currently available to predict GIB after acute stroke in routine clinical practice or clinical trials. In the present study, we aimed to develop and validate a risk model (acute ischemic stroke associated gastrointestinal bleeding score, the AIS-GIB score) to predict in-hospital GIB after acute ischemic stroke.
  
  
  METHODS
  The AIS-GIB score was developed from data in the China National Stroke Registry (CNSR). Eligible patients in the CNSR were randomly divided into derivation (60%) and internal validation (40%) cohorts. External validation was performed using data from the prospective Chinese Intracranial Atherosclerosis Study (CICAS). Independent predictors of in-hospital GIB were obtained using multivariable logistic regression in the derivation cohort, and β-coefficients were used to generate point scoring system for the AIS-GIB. The area under the receiver operating characteristic curve (AUROC) and the Hosmer-Lemeshow goodness-of-fit test were used to assess model discrimination and calibration, respectively.
  
  
  RESULTS
  A total of 8,820, 5,882, and 2,938 patients were enrolled in the derivation, internal validation and external validation cohorts. The overall in-hospital GIB after AIS was 2.6%, 2.3%, and 1.5% in the derivation, internal, and external validation cohort, respectively. An 18-point AIS-GIB score was developed from the set of independent predictors of GIB including age, gender, history of hypertension, hepatic cirrhosis, peptic ulcer or previous GIB, pre-stroke dependence, admission National Institutes of Health stroke scale score, Glasgow Coma Scale score and stroke subtype (Oxfordshire). The AIS-GIB score showed good discrimination in the derivation (0.79; 95% CI, 0.764-0.825), internal (0.78; 95% CI, 0.74-0.82) and external (0.76; 95% CI, 0.71-0.82) validation cohorts. The AIS-GIB score was well calibrated in the derivation (P = 0.42), internal (P = 0.45) and external (P = 0.86) validation cohorts.
  
  
  CONCLUSIONS
  The AIS-GIB score is a valid clinical grading scale to predict in-hospital GIB after AIS. Further studies on the effect of the AIS-GIB score on reducing GIB and improving outcome after AIS are warranted.
authors: Ruijun
authors: R
authors: Ji
authors: Haipeng
authors: H
authors: Shen
authors: Yuesong
authors: Y
authors: Pan
authors: Penglian
authors: P
authors: Wang
authors: Gaifen
authors: G
authors: Liu
authors: Yilong
authors: Y
authors: Wang
authors: Hao
authors: H
authors: Li
authors: Aneesh B
authors: AB
authors: Singhal
authors: Tiantan Comprehensive Stroke Center, Tiantan Hospital, Capital Medical University, No,6 Tiantanxili, Dongcheng District, Beijing 100050, China. yongjunwang1962@gmail.com.
authors: Yongjun
authors: Y
authors: Wang
mesh_terms: D000368:Aged; D020520:Brain Infarction / Q000453:epidemiology*; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010437:Peptic Ulcer / Q000453:epidemiology; D012042:Registries; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D020521:Stroke