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ORIGINAL RESEARCH article

Front. Med.

Sec. Gastroenterology

Volume 12 - 2025 | doi: 10.3389/fmed.2025.1586969

Risk factor analysis and nomogram for predicting massive postoperative gastrointestinal bleeding in patients with Crohn's disease: a multicenter retrospective study

Provisionally accepted
Mengyi ZhangMengyi Zhang1Danhua YaoDanhua Yao1Yuhua HuangYuhua Huang1Qi HeQi He1Yining HeYining He1Yiran JiaoYiran Jiao2Yuanruohan ZhangYuanruohan Zhang3Chunqiu ChenChunqiu Chen2*Zhe CuiZhe Cui3*Yousheng LiYousheng Li1*
  • 1Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
  • 2Shanghai Tenth People's Hospital, Tongji University, Shanghai, Shanghai Municipality, China
  • 3Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

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Background: Massive postoperative gastrointestinal bleeding is a severe postoperative complication of Crohn's disease (CD) with a high mortality rate, and deteriorating patients' recovery. However, there are few related studies, and it lacks effective prevention measures. Therefore, we conducted a multicenter study to explore the risk factors for massive postoperative gastrointestinal bleeding in CD patients.Methods: This study was a multicenter retrospective case-control study. Patients who were diagnosed with CD and underwent gastrointestinal (GI) surgery were enrolled.The control group was matched 1:4 for gender and age. By comparing perioperative medical information between two groups, risk factors were identified through logistic regression analysis. A nomogram was constructed and internally validation was performed by bootstrap resampling.Results: A total of 170 patients were included. Multivariable logistic regression revealed the independent predictors of massive postoperative gastrointestinal bleeding involving the number of previous abdominal surgeries (OR = 2.56, 95% CI = 1.54-4.24), GI bleeding history (OR = 6.17, 95% CI = 1.59-23.97), serum albumin (ALB) (OR = 0.88, 95% CI = 0.81-0.96), and Nutrition Risk Screening 2002 (OR = 1.57, 95% CI = 1.08-2.29). The nomogram achieved an area under the curve (AUC) value of 0.85 (95% CI: 0.76-0.93). In internal validation, the AUC value was 0.976 (95% CI: 0.955-0.997). Calibration curves showed good alignment. DCA demonstrated that the diagnostic model had good clinical efficiency.Conclusions: The risk of massive postoperative gastrointestinal bleeding in CD patients will be increased with a GI bleeding history, more previous abdominal surgeries, higher nutrition risk, and lower ALB level. Our nomogram model is effective and could be a useful tool for prediction.

Keywords: Crohn's disease, gastrointestinal bleeding, Postoperative complication, nomogram, Risk factors

Received: 04 Mar 2025; Accepted: 14 Jul 2025.

Copyright: © 2025 Zhang, Yao, Huang, He, He, Jiao, Zhang, Chen, Cui and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
Chunqiu Chen, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200070, Shanghai Municipality, China
Zhe Cui, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200000, China
Yousheng Li, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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