A Model for Predicting the Future Risk of Incident Erosive Esophagitis in an Asymptomatic Population Undergoing Regular Check-ups

Medicine (Baltimore). 2016 Jan;95(4):e2591. doi: 10.1097/MD.0000000000002591.

Abstract

Erosive esophagitis is a major risk factor for Barrett esophagus and esophageal adenocarcinoma. Information regarding the putative risk factors for developing erosive esophagitis is considerably heterogeneous; thus, a risk model is required to clinically predict the incidence of erosive esophagitis. This study was to derive and validate a predictive model for the incidence of developing erosive esophagitis after negative index endoscopy in a population subjected to routine health check-ups. This retrospective cohort study of health check-ups included 11,535 patients who underwent repeated screening endoscopy after >3 years from a negative index endoscopy. We used logistic regression analysis to predict the incidence of erosive esophagitis, and a Simple Prediction of Erosive Esophagitis Development score for risk assessment was developed and internally validated using the split-sample approach. The development and validation cohorts included 5765 patients (675 with erosive esophagitis [11.7%]) and 5770 patients (670 with erosive esophagitis [11.6%]), respectively. The final model included sex, smoking behavior, body mass index, hypertension, and the triglyceride level as variables. This model predicted 667 cases of erosive esophagitis, yielding an expected-to-observed ratio of 1.00 (95% confidence interval [CI], 0.92-1.07). A simplified 5-item risk scoring system based on coefficients was developed, with a risk of erosive esophagitis of 6.2% (95% CI, 5.2-7.1) for the low-risk group (score ≤2), 15.1% (95% CI, 13.5-16.6) for the intermediate-risk group (score ≤3, 4), and 18.2% (95% CI, 15.2-21.3) for the high-risk group (score ≥5). The discriminative performance of the risk-prediction score was consistent in the derivation cohort and validation cohort (c-statistics 0.68 and 0.64, respectively); the calibration was good (Brier score 0.099 and 0.1, respectively). In conclusion, a simple risk-scoring model using putative risk factors can predict the future incidence of developing erosive esophagitis in asymptomatic populations.

Publication types

  • Validation Study

MeSH terms

  • Adult
  • Biobehavioral Sciences*
  • Body Mass Index
  • Esophagitis, Peptic / diagnosis*
  • Esophagitis, Peptic / epidemiology*
  • Esophagoscopy
  • Female
  • Forecasting
  • Humans
  • Hypertension / epidemiology
  • Incidence
  • Male
  • Middle Aged
  • Physical Examination
  • ROC Curve
  • Republic of Korea / epidemiology
  • Retrospective Studies
  • Risk Assessment / methods
  • Risk Factors
  • Sex Factors
  • Smoking / epidemiology
  • Triglycerides / blood

Substances

  • Triglycerides