J Gastroenterol Hepatol. 2021 Sep 23. doi: 10.1111/jgh.15695. Online ahead of print.
ABSTRACT
BACKGROUND: The RHEMITT score (Renal disease; Heart failure; Endoscopic findings; Major bleeding; Incomplete SBCE; Tobacco; Treatment by enteroscopy), was the first score to accurately predict the individual risk of small bowel rebleeding after capsule endoscopy (SBCE).
AIM: Prospective validation of the RHEMITT score.
METHODS: Cohort of consecutive patients with mid gastrointestinal bleeding (MGIB) submitted to SBCE and followed prospectively, during at least 12 months, since 2017 until 2020. Rebleeding was defined as an overt bleeding event (melena or hematochezia) or a haemoglobin decrease of at least 2 g/dL. The RHEMITT score was calculated for each patient and the rebleeding rates compared. The performance of the score was tested by calculating the area under curve (AUC) of the ROC curve. A rebleeding-free survival was assessed, corresponding to the period between the date of SBCE and the date of the first post-SBCE rebleeding event.
RESULTS: We included 162 patients, 102 (62.9%) were female, with a mean age of 64 years-old. The sensitivities and specificities of the score grades for predicting rebleeding were as following: for low-risk patients, 0% [0-10%] and 28.8% [21.1-36.5%]; for intermediate-risk patients, 23.3% [8.2-38.4%] and 72% [64.3-79.7%]; for high-risk patients, 76.7% [61.6-91.8%] and 99.2% [97.7-100%], corresponding to an AUC of the ROC of 0.988 (p<0.001). Kaplan Meyer plots were statistically different according to the attributed risk (Log-Rank p-value <0.001; Breslow-Wilcoxon p-value <0.001).
CONCLUSION: The RHEMITT score performed with excellent discriminative power in predicting rebleeding risk, and we herewith propose a surveillance of MGIB patients guided by the RHEMITT score.
PMID:34555864 | DOI:10.1111/jgh.15695
