A Novel Prediction Tool for Mortality in Patients with Acute Lower Gastrointestinal Bleeding: A Large Multicenter Long-Term Cohort Study

Abstract Acute lower gastrointestinal bleeding in patients with poor long-term prognoses requires careful follow-up. This study aimed to identify predictors of long-term mortality in patients with acute hematochezia and construct a prognostic tool using a large dataset.The analysis included 8,254 patients with hematochezia requiring emergency hospitalization (from the CODE BLUE J-study). Data on vital signs, symptoms, initial laboratory findings, medications, comorbidities, diagnoses, and in-hospital procedures were comprehensively analyzed to develop a scoring model for 30-day and 1-year mortality outcomes.The 30-day and 1-year mortality rates were 0.9% and 3.0%, respectively. A highly accurate (C-index, 0.88) long-term prognostic scoring system known as the CACHEXIA score was constructed. The 1-year mortality rates for patients with low-, medium-, and high-risk CACHEXIA scores were 1.1%, 16.4%, and 63.4%, respectively. The predictors of 30-day mortality were included in the predictors of 1-year mortality, and the ROC-AUC for the short-term prognostic score was 0.93.Indicators of long-term prognosis in hematochezia cases were identified using extensive multicenter data. Even after being discharged, patients identified as high-risk using our unique prediction score need follow-up.