Risk factors and predictive model for gastrointestinal bleeding in patients with ischemic stroke: a case-control study

OBJECTIVE: To identify risk factors for gastrointestinal bleeding (GIB) in patients with ischemic stroke and to develop a clinically applicable predictive model. METHODS: A retrospective case-control study was conducted on ischemic stroke patients admitted to The Third People's Hospital of Hefei. The training cohort included 96 patients who developed GIB between January 2021 and January 2023 (as cases) and 104 age-matched stroke patients who did not develop GIB (as controls). Risk factors were identified using univariate and multivariate logistic regression analyses. A separate validation cohort (40 GIB-cases and 48 controls) admitted between February 2023 and June 2024 was used to assess model's performance. RESULTS: Univariate analysis identified several significant risk factors, including a history of gastrointestinal diseases, use of anticoagulants or antiplatelet drugs, a Glasgow Coma Scale (GCS) score ≤ 8, and prolonged prothrombin time (PT). Multivariate analysis showed that all four factors were independent predictors: history of stomach or intestinal disease (odds ratio [OR]=3.31, 95% confidence interval [CI]: 1.04-10.49), use of anticoagulants or antiplatelet drugs (OR=4.09, 95% CI: 1.68-9.99), GCS score ≤8 (OR=4.75, 95% CI: 1.18-19.16), and prolonged PT (OR=1.15, 95% CI: 1.04-1.28). A predictive nomogram based on these four factors demonstrated good performance, with an area under the curve (AUC) of 0.73 in the training cohort and 0.79 in the validation cohort. The calibration curve indicated that the nomogram's predictions matched closely with real outcomes. The decision curve analysis (DCA) also showed that the model provided evident clinical benefits. CONCLUSION: Four independent risk factors for GIB in ischemic stroke patients were identified. The developed nomogram may assist clinicians in early risk assessment and inform treatment decisions.