Dutta AK, et al. - In the present study, researchers prospectively develop and validate a simple clinical-cum-laboratory test-based scoring model to determine dyspeptic patients with high risk of upper gastrointestinal malignancy (UGIM). In identifying dyspeptic patients at risk of UGIM, this simple clinical-cum-laboratory test-based model performed very well and can serve as a beneficial decision-making tool for referral for endoscopy.

Methods

• For this investigation, adult patients with dyspeptic symptoms were prospectively enlisted over 5 years.
• Clinical details including alarm features were recorded.
• Blood tests for hemoglobin and albumin were done before endoscopy.
• The primary outcome was the presence of UGIM.
• Risk factors for UGIM were evaluated.
• A predictive scoring model was constructed based on the OR of significant factors.
• To identify optimal cutoff score, ROC curve was plotted.
• Using bootstrapping technique, the model was validated.

Results

• The investigation involved 2324 subjects (41.9 ± 12.8 years; 33.4% females).
• In 6.8% patients, UGIM was noted.
• The final model had following 5 positive predictors for UGIM—
  • age > 40 years (OR 3.3, score 1);
  • albumin ≤ 3.5 g% (OR 3.4, score 1);
  • Hb ≤ 11 g% (OR 3.3, score 1);
  • alarm features (OR 5.98, score 2);
  • recent onset of symptoms (OR 8.7, score 3).
• It was noted that ROC curve had an impressive AUC of 0.9 (0.88–0.93), and a score of 2 had 92.5% sensitivity in predicting UGIM.
• Validation by bootstrapping exhibited zero bias, which further strengthened the model.