Purpose: To develop and internally validate a novel prediction score to predict the occurrence of arterial–esophageal fistula (AEF) in esophageal cancer bleeding. Methods: This retrospective cohort study enrolled patients with esophageal cancer bleeding in the emergency department. The primary outcome was the diagnosis of AEF. The patients were randomly divided into a derivation group and a validation group. In the derivation stage, a predictive model was developed using logistic regression analysis. Subsequently, internal validation of the model was conducted in the validation cohort during the validation stage to assess its discrimination ability. Results: A total of 257 patients were enrolled in this study. All participants were randomized to a derivation cohort (n= 155) and a validation cohort (n= 102). AEF occurred in 22 patients (14.2%) in the derivation group and 14 patients (13.7%) in the validation group. A predictive model (HEARTS-Score) comprising five variables (hematemesis, active bleeding, serum creatinine level >1.2 mg/dL, prothrombin time >13 s, and previous stent implantation) was established. The HEARTS-Score demonstrated a high discriminative ability in both the derivation and validation cohorts, with c-statistics of 0.90 (95% CI 0.82–0.98) and 0.82 (95% CI 0.72–0.92), respectively. Conclusions: By employing this novel prediction score, clinicians can make more objective risk assessments, optimizing diagnostic strategies and tailoring treatment approaches.
目的：开发并内部验证一种新型预测评分，用于预测食管癌出血患者发生动脉-食管瘘（AEF）的风险。方法：本回顾性队列研究纳入了急诊科收治的食管癌出血患者，主要结局指标为AEF的诊断。患者被随机分为推导组和验证组。在推导阶段，采用逻辑回归分析构建预测模型；随后在验证阶段对模型进行内部验证，以评估其区分能力。结果：本研究共纳入257例患者，所有参与者被随机分配至推导队列（n=155）和验证队列（n=102）。推导组中22例患者（14.2%）发生AEF，验证组中14例患者（13.7%）发生AEF。最终建立了包含五个变量（呕血、活动性出血、血清肌酐水平>1.2 mg/dL、凝血酶原时间>13秒及既往支架植入史）的预测模型（HEARTS评分）。该评分在推导队列和验证队列中均表现出良好的区分能力，C统计值分别为0.90（95% CI 0.82-0.98）和0.82（95% CI 0.72-0.92）。结论：通过应用这一新型预测评分，临床医生可进行更客观的风险评估，从而优化诊断策略并制定个体化治疗方案。
肿瘤(癌症)患者之家