Development of a scoring system to evaluate peptic ulcer risks

Objective To develop a scoring system to determine peptic ulcer risks and to evaluate its screening efficiency. Methods A total of 862 people who underwent gastroscopy for the first time ranging from 18 to 45 years old were enrolled in this study. They were divided into two cohorts with the method of simple random sampling, 514 in the original cohort and 348 in the validation cohort. Information such as demographic characteristics, dietary intake, lifestyle, symptoms relating to peptic ulcer was obtained. A multivariable logistic regression method was used to determine independent predictors of peptic ulcer. Based on the logistic regression model, a scoring system was developed with a regression coefficient-based scoring method. Then the scoring system was internally and externally validated. Each value of calibration, discrimination and accuracy were computed and then compared with those of original cohort to assess its screening efficiency. Results Three variables (gender, smoking and melena) composed the scoring system with scores ranging from 0 to 4 points. It had good calibration (P=0.956) and discrimination (area under the ROC=0.70, 95%CI: 0.65-0.76). With 2.5 points as the screening cutoff value, the sensitivity, specificity, accuracy rate, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 49.5%, 82.2%, 75.5%, 41.6%, 86.4%, 2.78 and 0.61, respectively. In the validation cohort, the sensitivity, specificity, accuracy rate, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 27.2%, 92.7%, 71.3%, 64.6%, 72.3%, 3.89 and 0.79.The results above indicated that the screening efficiency of the scoring system in the original cohort was similar to that in the validation cohort. Conclusion The scoring system to determine peptic ulcer risks, containing gender, smoking and melena, has good screening efficiency and can be applied to predict the risks of peptic ulcer. Key words: Peptic ulcer; Incidence; Risk factors; Screening; Risk stratification