Machine learning based CAGIB score predicts in-hospital mortality of cirrhotic patients with acute gastrointestinal bleeding.

Journal: NPJ digital medicine
Published Date: Jul 31, 2025

Abstract

Acute gastrointestinal bleeding (AGIB) is a potentially lethal complication in cirrhosis. In this prospective international multi-center study, the performance of CAGIB score for predicting the risk of in-hospital death in 2467 cirrhotic patients with AGIB was validated. Machine learning (ML) models were established based on CAGIB components, and their area under curves (AUCs) were calculated and compared. Gray zone approach was employed to further stratify the risk of death. In training cohort, the AUC of CAGIB score was 0.789. Among the ML models, the least square support vector machine regression (LS-SVMR) model had the best predictive performance (AUC = 0.986). Patients were further divided into low- (LS-SVMR score <0.084), moderate- (LS-SVMR score 0.084-0.160), and high-risk (LS-SVMR score >0.160) groups with in-hospital mortality of 0.38%, 2.22%, and 64.37%, respectively. Statistical results were retained in validation cohort. LS-SVMR model has an excellent predictive performance for in-hospital death in cirrhotic patients with AGIB (ClinicalTrials.gov; NCT04662918).

Authors

  • Zhaohui Bai
    Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (Teaching Hospital of Shenyang Pharmaceutical University), Shenyang, China.
  • Su Lin
    Liver Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
  • Mingyu Sun
    School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, No. 66, Gongchang Road, Guangming District, Shenzhen 518107, China.
  • Shanshan Yuan
  • Mariana Barros Marcondes
    São Paulo State University (UNESP), Botucatu Medical School, São Paulo, Brazil.
  • Dapeng Ma
    Department of Critical Care Medicine, The Sixth People's Hospital of Dalian, Dalian, China.
  • Qiang Zhu
  • Yiling Li
    Department of Gastroenterology, The First Hospital of China Medical University, Shenyang, PR China. Electronic address: lyl-72@163.com.
  • Yingli He
    Department of Infectious Diseases, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
  • Cyriac Abby Philips
    Department of Clinical and Translational Hepatology, The Liver Institute, Center of Excellence in GI Sciences, Rajagiri Hospital, Kerala, India.
  • Xiaofeng Liu
    Changzhou Key Laboratory of Robots & Intelligent Technology, Hohai University, China.
  • Kanokwan Pinyopornpanish
    Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
  • Lichun Shao
    Department of Gastroenterology, Air Force Hospital of Northern Theater Command, Shenyang, China.
  • Nahum Méndez-Sánchez
    Medica Sur Clinic & Foundation, National Autonomous University of Mexico, Mexico City, Mexico.
  • Metin Başaranoğlu
  • Yunhai Wu
    Department of Critical Care Medicine, The Sixth People's Hospital of Shenyang, Shenyang, China.
  • Yu Chen
    State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
  • Ling Yang
    Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine Shanghai 201203 China pwang@shutcm.edu.cn.
  • Andrea Mancuso
    Medicina Interna 1, Azienda di Rilievo Nazionale ad Alta Specializzazione Civico-Di Cristina-Benfratelli, Palermo, Italy.
  • Frank Tacke
    Hepatology and Gastroenterology, Charité University Medicine, Berlin, Germany.
  • Bimin Li
    Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China. lbmjx@163.com.
  • Lei Liu
    Department of Science and Technology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
  • Fanpu Ji
    Department of Hepatology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China. jifanpu1979@163.com.
  • Xingshun Qi
    Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (Teaching Hospital of Shenyang Pharmaceutical University), Shenyang, China. xingshunqi@126.com.

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