External validation of the NOBLADS score, a risk scoring system for severe acute lower gastrointestinal bleeding

• Published in: PloS one Vol. 13; no. 4; p. e0196514
• Main Authors: Aoki, Tomonori, Yamada, Atsuo, Nagata, Naoyoshi, Niikura, Ryota, Hirata, Yoshihiro, Koike, Kazuhiko
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 26.04.2018; Public Library of Science (PLoS)
• Subjects: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Analysis; Anti-inflammatory agents; Antiplatelet therapy; Area Under Curve; Biology and Life Sciences; Bleeding; Blood; Blood pressure; Blood Transfusion; Blood transfusions; Clinical decision making; Colonoscopy; Decision making; Derivation; Diarrhea; Endoscopy; Female; Gastroenterology; Gastrointestinal hemorrhage; Gastrointestinal Hemorrhage - diagnosis; Gastrointestinal Hemorrhage - pathology; Health aspects; Hemorrhage; Hospital Mortality; Hospital patients; Hospitalization; Hospitals; Humans; Inflammation; Intervention; Male; Medical records; Medicine; Medicine and Health Sciences; Middle Aged; Mortality; Neural networks; Nonsteroidal anti-inflammatory drugs; Patients; Prediction models; Radiology; Retrospective Studies; Risk; Risk Factors; ROC Curve; Severity of Illness Index; Steroidal anti-inflammatory agents; Syncope; Transfusion; Young Adult; Japan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0196514

We aimed to evaluate the generalizability of NOBLADS, a severe lower gastrointestinal bleeding (LGIB) prediction model which we had previously derived when working at a different institution, using an external validation cohort. NOBLADS comprises the following factors: non-steroidal anti-inflammatory drug use, no diarrhea, no abdominal tenderness, blood pressure ≤ 100 mmHg, antiplatelet drug use, albumin < 3.0 g/dL, disease score ≥ 2, and syncope. We retrospectively analyzed 511 patients emergently hospitalized for acute LGIB at the University of Tokyo Hospital, from January 2009 to August 2016. The areas under the receiver operating characteristic curves (ROCs-AUCs) for severe bleeding (continuous and/or recurrent bleeding) were compared between the original derivation cohort and the external validation cohort. Severe LGIB occurred in 44% of patients. Several clinical factors were significantly different between the external and derivation cohorts (p < 0.05), including background, laboratory data, NOBLADS scores, and diagnosis. The NOBLADS score predicted the severity of LGIB with an AUC value of 0.74 in the external validation cohort and one of 0.77 in the derivation cohort. In the external validation cohort, the score predicted the risk for blood transfusion need (AUC, 0.71), but was not adequate for predicting intervention need (AUC, 0.54). The in-hospital mortality rate was higher in patients with a score ≥ 5 than in those with a score < 5 (AUC, 0.83). Although the external validation cohort clinically differed from the derivation cohort in many ways, we confirmed the moderately high generalizability of NOBLADS, a clinical risk score for severe LGIB. Appropriate triage using this score may support early decision-making in various hospitals.