Development and validation of a predictive model for upper gastrointestinal bleeding in peritoneal dialysis patients: a retrospective, multicenter cohort study

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Abstract
The incidence of upper gastrointestinal bleeding (UGIB) in peritoneal dialysis (PD) patients was higher than that in the general population. Although there have been studies on the risk factors of UGIB in PD patients, few studies had established the model of UGIB in PD patients. The purpose of this study was to establish and verify a predictive model of UGIB in PD patients. This retrospective study was conducted between February 1, 2007, and November 15, 2021. The patients were divided into training and validation sets in a 1:1 ratio. The least absolute shrinkage and selection operator (LASSO) regression was used to screen potential risk factors for UGIB. These risk factors were used to generate a prognostic nomogram. The nomogram model predictive performance was evaluated by receiver operating characteristic (ROC)curves, calibration curves and decision curve analysis (DCA). A total of 2107 eligible patients were included in this study. 114 patients suffered from UGIB. After LASSO regression analysis, five representative variables were included in the nomogram: the use of calcium, the use of proton pump inhibitors (PPIs), the history of UGIB, hemoglobin, and uric acid. The C-index of the training set was 0.859 (0.810–0.909), and the C-index of the validation set was 0.874 (0.829–0.919). Using Calcium and PPIs, the history of UGIB, hemoglobin, and uric acid were important predictors of UGIB in PD patients. The nomogram developed and validated in this study has the potential to become an effective tool for clinicians to predict UGIB in PD patients.

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