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Background <p>The rebleeding rate in patients with suspected small-bowel bleeding (SSBB) ranges from 19% to 41.7%. However, the predictive factors and long-term risks of rebleeding across different clinical populations remain insufficiently clarified. To fill this gap, the present study aimed to develop the COPPE score integrating capsule endoscopy (CE) findings and clinical factors for assessing rebleeding risk in SSBB patients after CE examination.</p> Methods <p>A total of 321 patients with SSBB from four centers between October 2015 and April 2022 were retrospectively analyzed and randomly divided into a training set (<i>n</i> = 229) and a validation set (<i>n</i> = 92) at a 7:3 ratio. The COPPE score was constructed using LASSO-Cox regression. Its performance was evaluated and compared with the RHEMITT score, and a personalized follow-up strategy was explored.</p> Results <p>During a mean follow-up of 25.0&#xa0;months, rebleeding occurred in 22.7% of patients. Five independent risk factors were ultimately identified: positive CE findings (3 points), chronic liver disease (3 points), previous gastrointestinal bleeding history (3 points), overt bleeding duration &gt; 3&#xa0;months (2 points), and elevated serum urea (2 points). The COPPE score, built on these five indicators, ranged from 0 to 13 points, with C‑index of 0.77 (95% CI 0.71–0.83) in the training set and 0.71 (95% CI 0.60–0.81) in the validation set. Time‑dependent AUCs for predicting rebleeding at 6–18&#xa0;months were 0.73–0.78, which were significantly superior to those of the RHEMITT score (0.57–0.60, <i>P</i> &lt; 0.05). Using 4 points as the optimal cut-off value, patients were stratified into a low‑risk group (0–4 points) and a high‑risk group (5–13 points). Based on the survival characteristics of the high‑risk group, a phased exploratory follow-up protocol was further proposed.</p> Conclusions <p>The COPPE score can effectively stratify rebleeding risk in Chinese SSBB patients. It helps clinicians distinguish high-risk patients for close monitoring and timely intervention, and formulate simplified follow-up plans for low-risk cases, so as to support individualized clinical management.</p>

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A novel prediction score for rebleeding in suspected small-bowel bleeding post-capsule endoscopy examination: a multicenter, retrospective cohort study

  • 期刊论文

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  • 发表日期：

    2026年6月22日

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  • Xiajiao Tang,
  • Mingyue Li,
  • Cuie Cheng,
  • Lei Wang,
  • Jian Cao,
  • Fenying Lu,
  • Shuling Huang,
  • Lu Chen,
  • Ruihua Shi

摘要

Background

The rebleeding rate in patients with suspected small-bowel bleeding (SSBB) ranges from 19% to 41.7%. However, the predictive factors and long-term risks of rebleeding across different clinical populations remain insufficiently clarified. To fill this gap, the present study aimed to develop the COPPE score integrating capsule endoscopy (CE) findings and clinical factors for assessing rebleeding risk in SSBB patients after CE examination.

Methods

A total of 321 patients with SSBB from four centers between October 2015 and April 2022 were retrospectively analyzed and randomly divided into a training set (n = 229) and a validation set (n = 92) at a 7:3 ratio. The COPPE score was constructed using LASSO-Cox regression. Its performance was evaluated and compared with the RHEMITT score, and a personalized follow-up strategy was explored.

Results

During a mean follow-up of 25.0 months, rebleeding occurred in 22.7% of patients. Five independent risk factors were ultimately identified: positive CE findings (3 points), chronic liver disease (3 points), previous gastrointestinal bleeding history (3 points), overt bleeding duration > 3 months (2 points), and elevated serum urea (2 points). The COPPE score, built on these five indicators, ranged from 0 to 13 points, with C‑index of 0.77 (95% CI 0.71–0.83) in the training set and 0.71 (95% CI 0.60–0.81) in the validation set. Time‑dependent AUCs for predicting rebleeding at 6–18 months were 0.73–0.78, which were significantly superior to those of the RHEMITT score (0.57–0.60, P < 0.05). Using 4 points as the optimal cut-off value, patients were stratified into a low‑risk group (0–4 points) and a high‑risk group (5–13 points). Based on the survival characteristics of the high‑risk group, a phased exploratory follow-up protocol was further proposed.

Conclusions

The COPPE score can effectively stratify rebleeding risk in Chinese SSBB patients. It helps clinicians distinguish high-risk patients for close monitoring and timely intervention, and formulate simplified follow-up plans for low-risk cases, so as to support individualized clinical management.