Objective  To identify influencing factors for emergency endoscopic in-tervention in patients with acute non-variceal upper gastrointestinal bleeding (ANVUGIB) and to develop a predictive model.

Methods  Clinical data from patients with ANVUGIB admitted to the General Hospital of Central Theater Command from January 2022 to April 2025 were retrospectively collected, they were divided into intervention group and non intervention group according to whether endoscopic intervention was performed within 24 hours after admission. Patients admitted from January 2022 to August 2024 were included in the training set, and those admitted from September 2024 to April 2025 were included in the validation set. In the training set, propensity score matching (PSM) was used to balance confounders, and clinical outcomes were compared between the intervention and non-intervention groups. Lasso regression was used to screen predictor variables, and a nomogram was developed using multivariable Logistic regression. The predictive ability and accuracy of the model were assessed using the receiver operating characteristic (ROC) curve, area under the curve (AUC), calibration curve, and Hosmer-Lemeshow test. Decision curve analysis (DCA) and clinical impact curve (CIC) were used to evaluate the clinical utility of the model, which was further validated in the validation set.

Results  A total of 732 patients were included, with 584 in the training set and 148 in the validation set. After PSM, there were 68 patients in the intervention group and 136 patients in the non-intervention group in the training set. Compared to the non-intervention group, the intervention group showed better clinical outcomes in terms of rebleeding rate and length of hospital stay. Lasso and Logistic regression analyses showed that hematemesis, pulse rate, systolic blood pressure, history of peptic ulcer, and platelet count were factors associated with endoscopic intervention. The AUC of the predictive model was 0.783. The calibration curve was close to the ideal diagonal line, and the Hosmer-Lemeshow test showed good model fit (P=0.153). The AUC for internal cross-validation was 0.775, and the AUC in the validation set was 0.778. Both DCA and CIC indicated that the model had potential clinical application value.

Conclusion  The Endoscopic Intervention Score is composed of simple and objective predictors that can be readily obtained early after admission and has good predictive  performance.

1.Lanas A, Dumonceau JM, Hunt RH, et al. Non-variceal upper gastrointestinal bleeding[J]. Nat Rev Dis Primers, 2018, 4: 18020.

2.Qian O, Zhang Q, Pan Y, et al. Endoscopic thermocoagulation hemostasis for acute non-variceal upper gastrointestinal hemorrhage: a randomized controlled study[J]. Surg Endosc, 2022, 36(2): 1578-1583.

3.Horibe M, Iwasaki E, Matsuzaki J, et al. Superiority of urgent vs early endoscopic hemostasis in patients with upper gastrointestinal bleeding with high-risk stigmata[J]. Gastroenterol Rep (Oxf), 2021, 9(6): 543-551.

4.Stanley AJ, Laine L, Dalton HR, et al. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study[J]. BMJ, 2017, 356: i6432.

5.Barkun AN, Almadi M, Kuipers EJ, et al. Management of nonvariceal upper gastrointestinal bleeding: guideline recommendations from the international consensus group[J]. Ann Intern Med, 2019, 171(11): 805-822.

6.《中华内科杂志》编辑委员会, 《中华医学杂志》编辑委员会, 《中华消化杂志》编辑委员会, 等. 急性非静脉曲张性上消化道出血诊治指南(2018年, 杭州)[J]. 中华内科杂志, 2019, 58(3): 173-180. [Editorial Board of Chinese Journal of Internal Medicine, Editorial Board of Chinese Medical Journal, Editorial Board of Chinese Journal of Digestion, et al. Guidelines for the diagnosis and treatment of acute non-variceal upper gastrointestinal bleeding (2018, Hangzhou)[J]. Chinese Journal of Internal Medicine, 2019, 58(3): 173-180.]

7.Xu Y, Huang Y, Yuan Z, et al. Systematic evaluation of therapeutic effectiveness of Azvudine in treating COVID-19 hospitalized patients: a retrospective cohort study[J]. Front Cell Infect Microbiol, 2024, 14: 1453234.

8.Barkun AN, Alali A. The role of hemostatic powder in endoscopic hemostasis of nonvariceal upper gastrointestinal bleeding[J]. Ann Intern Med, 2022, 175(2): 289-290.

9.Zhang ZF, Guo FJ. Is topical tranexamic acid combined with endoscopic hemostasis superior to endoscopic hemostasis alone?[J]. Gastrointest Endosc, 2023, 98(6): 1037.

10.Lau JYW, Yu Y, Tang RSY, et al. Timing of endoscopy for acute upper gastrointestinal bleeding[J]. N Engl J Med, 2020, 382(14): 1299-1308.

11.张玲玉,鲁明,徐斌,等. 老年急性上消化道出血死亡相关因素及ABC评分对其死亡风险的预测价值[J]. 西部医学, 2025, 37(7): 999-1003, 1010. [Analysis of factors associated with death in elderly patients with acute upper gastrointestinal bleeding and predictive value of the ABC score for mortality risk[J]. Medical Journal of West China, 2025, 37(7): 999-1003, 1010.]

12.Akhila Arya PV, Thulaseedharan NK, Raj R, et al. AIMS65, Glasgow-Blatchford bleeding score and modified Glasgow-Blatchford bleeding score in predicting outcomes of upper gastrointestinal bleeding: an accuracy and calibration study[J]. Indian J Gastroenterol, 2023, 42(4): 496-504.

13.Rivieri S, Carron PN, Schoepfer A, et al. External validation and comparison of the Glasgow-Blatchford score, modified Glasgow-Blatchford score, Rockall score and AIMS65 score in patients with upper gastrointestinal bleeding: a cross-sectional observational study in western Switzerland[J]. Eur J Emerg Med, 2023, 30(1): 32-39.

14.Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper gastrointestinal haemorrhage[J]. Lancet, 2000, 356(9238): 1318-1321.

15.Franco MC, Jang S, da Costa Martins B, et al. Risk stratification in cancer patients with acute upper gastrointestinal bleeding: comparison of Glasgow-Blatchford, Rockall and AIMS65, and development of a new scoring system[J]. Clin Endosc, 2022, 55(2): 240-247.

16.Robertson M, Majumdar A, Boyapati R, et al. Risk stratification in acute upper GI bleeding: comparison of the AIMS65 score with the Glasgow-Blatchford and Rockall scoring systems[J]. Gastrointest Endosc, 2016, 83(6): 1151-1160.

17.Sasaki Y, Abe T, Kawamura N, et al. Prediction of the need for emergency endoscopic treatment for upper gastrointestinal bleeding and new score model: a retrospective study[J]. BMC Gastroenterol, 2022, 22(1): 337.

18.Maley JH. Hemoptysis or hematemesis?—The importance of professional medical interpretation: a teachable moment[J]. JAMA Intern Med, 2018, 178(6): 841-842.

19.Li Y, Li H, Zhu Q, et al. Effect of acute upper gastrointestinal bleeding manifestations at admission on the in-hospital outcomes of liver cirrhosis: hematemesis versus melena without hematemesis[J]. Eur J Gastroenterol Hepatol, 2019, 31(11): 1334-1341.

20.Lee YJ, Kim ES, Hah YJ, et al. Chronic kidney disease, hemodynamic instability, and endoscopic high-risk appearance are associated with 30-day rebleeding in patients with non-variceal upper gastrointestinal bleeding[J]. J Korean Med Sci, 2013, 28(10): 1500-1506.

21.薛晓霞, 胡松, 毛拥军, 等. 老年住院患者非静脉曲张性上消化道出血的相关因素研究[J]. 中华老年医学杂志, 2022, 41(8): 965-969. [Xue XX, Hu S, Mao YJ, et al. Study on factors associated with non-variceal upper gastrointestinal bleeding in hospitalized elderly patients[J]. Chinese Journal of Geriatrics, 2022, 41(8): 965-969.]

22.Goel R, Chappidi MR, Patel EU, et al. Trends in red blood cell, plasma, and platelet transfusions in the United States, 1993-2014[J]. JAMA, 2018, 319(8): 825-827.

23.周益民, 陈荣琳, 龚中明, 等. 休克指数预测急性上消化道出血患者预后的价值[J]. 中国社区医师, 2023, 39(5): 115-117, 120. [Zhou YM, Chen RL, Gong ZM, et al. Predictive value of shock index on prognosis of patients with acute upper gastrointestinal hemorrhage[J]. Chinese Community Doctors, 2023, 39(5): 115-117, 120.]