title: A Model for Predicting the Future Risk of Incident Erosive Esophagitis in an Asymptomatic Population Undergoing Regular Check-ups.
abstract: Erosive esophagitis is a major risk factor for Barrett esophagus and esophageal adenocarcinoma. Information regarding the putative risk factors for developing erosive esophagitis is considerably heterogeneous; thus, a risk model is required to clinically predict the incidence of erosive esophagitis. This study was to derive and validate a predictive model for the incidence of developing erosive esophagitis after negative index endoscopy in a population subjected to routine health check-ups. This retrospective cohort study of health check-ups included 11,535 patients who underwent repeated screening endoscopy after >3 years from a negative index endoscopy. We used logistic regression analysis to predict the incidence of erosive esophagitis, and a Simple Prediction of Erosive Esophagitis Development score for risk assessment was developed and internally validated using the split-sample approach. The development and validation cohorts included 5765 patients (675 with erosive esophagitis [11.7%]) and 5770 patients (670 with erosive esophagitis [11.6%]), respectively. The final model included sex, smoking behavior, body mass index, hypertension, and the triglyceride level as variables. This model predicted 667 cases of erosive esophagitis, yielding an expected-to-observed ratio of 1.00 (95% confidence interval [CI], 0.92-1.07). A simplified 5-item risk scoring system based on coefficients was developed, with a risk of erosive esophagitis of 6.2% (95% CI, 5.2-7.1) for the low-risk group (score ≤2), 15.1% (95% CI, 13.5-16.6) for the intermediate-risk group (score ≤3, 4), and 18.2% (95% CI, 15.2-21.3) for the high-risk group (score ≥5). The discriminative performance of the risk-prediction score was consistent in the derivation cohort and validation cohort (c-statistics 0.68 and 0.64, respectively); the calibration was good (Brier score 0.099 and 0.1, respectively). In conclusion, a simple risk-scoring model using putative risk factors can predict the future incidence of developing erosive esophagitis in asymptomatic populations.
authors.affiliation: From the Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (SHK, HL, YWM, B-HM, JHL, HJS, P-LR, JJK); Department of Statistics, Pukyong National University, Pusan, Republic of Korea (YL); Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (JK, SC); Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (HJS); and Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea (SR).
authors.forename: Soo Hoon
authors.initials: SH
authors.lastname: Kang
authors.forename: Yaeji
authors.initials: Y
authors.lastname: Lim
authors.forename: Hyuk
authors.initials: H
authors.lastname: Lee
authors.forename: Joungyoun
authors.initials: J
authors.lastname: Kim
authors.forename: Sangah
authors.initials: S
authors.lastname: Chi
authors.forename: Yang Won
authors.initials: YW
authors.lastname: Min
authors.forename: Byung-Hoon
authors.initials: BH
authors.lastname: Min
authors.forename: Jun Haeng
authors.initials: JH
authors.lastname: Lee
authors.forename: Hee Jung
authors.initials: HJ
authors.lastname: Son
authors.forename: Seungho
authors.initials: S
authors.lastname: Ryu
authors.forename: Poong-Lyul
authors.initials: PL
authors.lastname: Rhee
authors.forename: Jae J
authors.initials: JJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D000066949:Biobehavioral Sciences; D015992:Body Mass Index; D004942:Esophagitis, Peptic / Q000175:diagnosis* / Q000453:epidemiology*; D004945:Esophagoscopy; D005260:Female; D005544:Forecasting; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D012372:ROC Curve; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology; D014280:Triglycerides / Q000097:blood
chemical_list: D014280:Triglycerides
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