Key result
A risk prediction score for serious gastrointestinal complications in elderly NSAID users achieved an area under the receiver operating characteristic curve of 0.77 (95% CI 0.75-0.80) in validation.
Why the study?
Few studies have quantified the impact of risk factors on gastrointestinal complications in elderly NSAID users, despite their high risk of GI bleeding.
Can a risk prediction score accurately identify elderly NSAID users at high risk for serious GI complications?
Case-Control (n=344,487)
Can a risk prediction score accurately identify elderly NSAID users at high risk for serious GI complications?
Effect estimate: AUC 0.77 (95% CI 0.75-0.80)
A newly derived risk prediction score can identify elderly NSAID users at high risk for serious GI complications with good discrimination.
May aid gastroprotection targeting in high-risk elderly NSAID users; hypothesis-generating pending prospective validation and outcome trials.
Aim: Although there is a high risk of gastrointestinal (GI) bleeding in the elderly, few studies have quantified the impact of risk factors on GI complications in elderly nonsteroidal anti-inflammatory drug (NSAID) users. This study aimed to develop and validate a risk prediction score to identify high-risk elderly patients using NSAID for severe GI complications. Methods: We used the following two Korean claims datasets: customized data with an enrollment period 2016–2017 for model development, and the sample data in 2019 for external validation. We conducted a nested case-control study for model development and validation. NSAID users were identified as the elderly (≥ 65 years) who received NSAIDs for more than 30 days. Patients who experienced serious GI complications, defined as hospitalizations or emergency department visits, were diagnosed with GI bleeding or perforation. We derived a model using logistic regression and cross-validation. Results: In the external validation cohort, we identified 372 cases from 254,551 patients. We identified 8,176 cases and 81,760 controls with a 1:10 matched follow-up period in the derivation cohort. In the external validation cohort, we identified 372 cases from 254,551 patients. The risk predictors were high-dose NSAIDs, NSAID type, complicated GI ulcer history, male sex, concomitant gastroprotective agents, relevant co-medications, severe renal disease, and cirrhosis. Area under the receiver operating characteristic curves was 0.77 (95% confidence interval, 0.75–0.80) in the external validation dataset. Conclusion: The prediction model may be a useful tool for reducing the risk of serious GI complications by identifying high-risk elderly patients.
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Lee et al. (2022) conducted a case-control in Serious gastrointestinal complications (n=344,487). Risk prediction score was evaluated on Serious GI complications (hospitalizations or emergency department visits diagnosed with GI bleeding or perforation) (AUC 0.77, 95% CI 0.75-0.80). A risk prediction score for serious gastrointestinal complications in elderly NSAID users achieved an area under the receiver operating characteristic curve of 0.77 (95% CI 0.75-0.80) in validation.
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