New predictive model of rebleeding during follow-up of patents with obscure gastrointestinal bleeding: A multicenter cohort study.
OBJECTIVE
The long-term recurrence rate of patients with obscure gastrointestinal bleeding (OGIB) who underwent video capsule endoscopy (VCE) remains unknown. Our study aimed to identify the cumulative incidence of rebleeding, develop a predictive model of rebleeding, and evaluate whether the model can be applied in other outcomes among patients with OGIB.


METHODS
We conducted a multicenter retrospective cohort study of 320 patients with OGIB who underwent VCE between 2009 and 2014. A rebleeding model was developed using multivariate Cox proportional hazards analysis and evaluated using Harrell's c-index.


RESULTS
Rebleeding occurred in 43 patients (13.4%) during a mean follow-up period of 18.3 (standard error, 0.9) months. The rebleeding sources were the small intestine (n = 17), extra-small intestine (n = 13), and unknown (n = 13). The cumulative incidence of rebleeding was 11.0% at 12 months and 35.3% at 60 months. Multivariate analysis revealed that female gender, liver cirrhosis, warfarin use, overt bleeding, and positive VCE findings were significant predictors of rebleeding. The rebleeding rate was 0% in patients with no predictors and 40% in patients with full predictors (P < 0.01). The model presented a high predictive accuracy (c-statistic, 0.733). Patients with higher predictors exhibited higher transfusion requirements, longer length of stay, and higher mortality (P < 0.01).


CONCLUSIONS
The cumulative incidence of rebleeding at 12 and 60 months was 11.0% and 35.3%, respectively. Five factors enable prediction of not only rebleeding but also transfusion requirements, length of stay, and death in OGIB patients.
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Ryota
R
Niikura
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Atsuo
A
Yamada
Department of Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.
Naoyoshi
N
Nagata
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Yuka
Y
Kobayashi
Department of Gastroenterology, JR Tokyo General Hospital, Tokyo, Japan.
Makoto
M
Okamoto
Department of Gastroenterology, Japanese Red Cross Medical Center, Tokyo, Japan.
Yuzo
Y
Mitsuno
Department of Gastroenterology, Tokyo Metropolitan Police Hospital, Tokyo, Japan.
Keiji
K
Ogura
Endoscopy and Endoscopic Surgery, The University of Tokyo Hospital, Tokyo, Japan.
Shuntaro
S
Yoshida
Ohta Nishinouchi Hospital, Fukushima, Japan.
Takuro
T
Shimbo
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Yoshihiro
Y
Hirata
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Kazuhiko
K
Koike
D000368:Aged; D001803:Blood Transfusion / Q000706:statistics & numerical data; D053704:Capsule Endoscopy; D015331:Cohort Studies; D019992:Databases as Topic; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015337:Multicenter Studies as Topic; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors
OGIB; mortality; natural history; obscure gastrointestinal bleeding; rebleeding