Academic Journal
Interpretable LightGBM model for predicting postoperative gastrointestinal hemorrhage in elderly hip fracture patients: leveraging systemic inflammation and medication exposures for personalized risk stratification.
| Title: | Interpretable LightGBM model for predicting postoperative gastrointestinal hemorrhage in elderly hip fracture patients: leveraging systemic inflammation and medication exposures for personalized risk stratification. |
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| Authors: | Sai H; Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, No 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, P. R. China., Ren J; Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, No 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, P. R. China., Ma X; Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, No 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, P. R. China., Yang K; Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, No 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, P. R. China., Bai C; Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, No 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, P. R. China., Liu M; Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, No 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, P. R. China., Zhao F; Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, No 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, P. R. China., Chen H; Joint Knee Protection Center, Hebei Medical University Third Hospital, Shijiazhuang, China., Li X; Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, No 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, P. R. China. 13363889051@126.com. |
| Source: | BMC geriatrics [BMC Geriatr] 2026 May 02; Vol. 26 (1). Date of Electronic Publication: 2026 May 02. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: BioMed Central Country of Publication: England NLM ID: 100968548 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2318 (Electronic) Linking ISSN: 14712318 NLM ISO Abbreviation: BMC Geriatr Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: London : BioMed Central, [2001]- |
| MeSH Terms: | Gastrointestinal Hemorrhage*/etiology , Gastrointestinal Hemorrhage*/diagnosis , Gastrointestinal Hemorrhage*/epidemiology , Hip Fractures*/surgery , Postoperative Hemorrhage*/diagnosis , Postoperative Hemorrhage*/epidemiology , Postoperative Hemorrhage*/etiology , Boosting Machine Learning Algorithms* , Inflammation*, Anti-Inflammatory Agents, Non-Steroidal/adverse effects ; Risk Assessment/methods ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Retrospective Studies ; Risk Factors |
| Abstract: | Background: Postoperative gastrointestinal (GI) bleeding is a serious complication after hip fracture surgery in older adults, yet perioperative risk stratification remains limited because commonly used GI-bleeding scores are not tailored to orthopedic settings. This study aimed to develop and internally validate an interpretable model to predict postoperative GI bleeding risk in elderly hip fracture patients, using data routinely available during the perioperative period. Methods: We retrospectively included 342 elderly patients who underwent hip fracture surgery at the Third Hospital of Hebei Medical University from January to December 2023. The outcome was GI bleeding within 1 month after surgery, confirmed by medical records and/or telephone follow-up. Patients were randomly split into a training set (n = 242) and a validation set (n = 100). Predictors were screened using LASSO with 10-fold cross-validation, followed by multivariable logistic regression to identify independent risk factors. Ten prediction algorithms were trained and compared. Model performance was assessed by AUC, calibration, and decision curve analysis, and interpretability was evaluated using SHAP. Results: GI bleeding occurred in 38 patients (11.1%). Multivariable analysis identified four independent predictors: alcohol consumption history (OR 8.109, 95% CI 2.463-26.69), glucocorticoid use (OR 4.922, 95% CI 1.055-22.97), NSAID use (OR 6.851, 95% CI 1.811-25.915), and higher systemic immune-inflammation index (SII) (OR 1.001, 95% CI 1.000-1.002). Among the tested models, LightGBM showed the best overall performance, with AUCs of 0.843 (training) and 0.817 (validation), good calibration, and the highest net benefit on decision curve analysis. SHAP results ranked feature importance as SII, NSAID use, alcohol consumption history, and glucocorticoid use, consistent with regression findings. Conclusions: We developed and validated an interpretable LightGBM model that predicts postoperative GI bleeding risk in elderly hip fracture patients using routinely available clinical data. The final model incorporates only preoperative variables, systemic inflammation, NSAID use, alcohol history, and glucocorticoid use, supporting its application for early risk stratification prior to surgery. (© 2026. The Author(s).) |
| Competing Interests: | Declarations. Ethics approval and consent to participate: The Ethics Committee of the Third Hospital of Hebei Medical University approved the study protocol (approval number: KS2023-068-1; approval date: 1 August 2023). This study is a retrospective cohort study, exempt from informed consent. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. |
| References: | Chen G-Y, Wu W-T, Lee R-P, Chen I-H, Yu T-C, Wang J-H, et al. Incidence of acute upper gastrointestinal bleeding and related risk factors among elderly patients undergoing surgery for major limb fractures: an analytical cohort study. Healthcare. 2023;11(21). Chuene MA, Pietrzak JRT, Sekeitto AR, Mokete L. Should we routinely prescribe proton pump inhibitors peri-operatively in elderly patients with hip fractures? A review of the literature. EFORT Open Reviews. 2021;6(8):686–91. (PMID: 10.1302/2058-5241.6.200053345320768419798) Tian M, Li W, Wang Y, Tian Y, Zhang K, Li X, et al. Risk factors for perioperative acute heart failure in older hip fracture patients and establishment of a nomogram predictive model. J Orthop Surg Res. 2023;18(1). Singh R, Trickett R, Meyer CER, Lewthwaite S, Ford D. Prophylactic proton pump inhibitors in femoral neck fracture patients – A life - and cost-saving intervention. Annals Royal Coll Surg Engl. 2016;98(6):371–5. (PMID: 10.1308/rcsann.2016.0106) Fisher L, Fisher A, Pavli P, Davis M. Perioperative acute upper gastrointestinal haemorrhage in older patients with hip fracture: incidence, risk factors and prevention. Aliment Pharmacol Ther. 2007;25(3):297–308. (PMID: 10.1111/j.1365-2036.2006.03187.x17217452) Liu J, Gupta R, Hay K, Pulle C, Rahman T, Pandy S. Upper gastrointestinal bleeding in neck of femur fracture patients: a single tertiary centre experience. Intern Med J. 2018;48(6):731–5. (PMID: 10.1111/imj.1380929898280) Liu L, Yuan Y, Zeng J, Zhu G, Su X, Gong X, et al. Development and validation of a nomogram for predicting postoperative new-onset constipation in elderly patients undergoing hip fracture surgery. Sci Rep. 2025;15(1):15289. https://doi.org/10.1038/s41598-025-00493-6 . Stanley AJ, Laine L, Dalton HR, Ngu JH, Schultz M, Abazi R, et al. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study. BMJ. 2017;356:i6432. https://doi.org/10.1136/bmj.i6432 . Rivieri S, Carron P-N, Schoepfer A, Ageron F-X. External validation and comparison of the Glasgow-Blatchford score, modified Glasgow-Blatchford score, Rockall score and AIMS65 score in patients with upper gastrointestinal bleeding: a cross-sectional observational study in Western Switzerland. Eur J Emerg Med. 2022;30(1):32–9. (PMID: 10.1097/MEJ.00000000000009833654233510405788) Wang L, Wu M, Zhu C, Li R, Bao S, Yang S, et al. Ensemble learning based on efficient features combination can predict the outcome of recurrence-free survival in patients with hepatocellular carcinoma within three years after surgery. Front Oncol. 2022;12:1019009. https://doi.org/10.3389/fonc.2022.1019009 . Kataoka Y, Kimura Y, Ikenoue T, Matsuoka Y, Matsumoto J, Kumasawa J, et al. Integrated model for COVID-19 diagnosis based on computed tomography artificial intelligence, and clinical features: a multicenter cohort study. Annals Translational Med. 2022;10(3):130. (PMID: 10.21037/atm-21-5571) Sevransky JE, Checkley W, Herrera P, Pickering BW, Barr J, Brown SM, et al. Protocols and Hospital Mortality in Critically Ill Patients. Crit Care Med. 2015;43(10):2076–84. (PMID: 10.1097/CCM.0000000000001157261104885673100) Krishnan S, Koshy G, Reddy A, Rajeev A. The role of endoscopy in investigating the causes of persistent anaemia in post-operative fractured neck of femur patients. Cureus. 2023;15(10):e47982. https://doi.org/10.7759/cureus.47982 . Rodriguez S, Pertino MW, Arcos C, Reichert L, Echeverria J, Simirgiotis M, et al. Isolation, gastroprotective effects and untargeted metabolomics analysis of Lycium Minutifolium J. Remy (Solanaceae). Foods. 2020;9(5):565. https://doi.org/10.3390/foods9050565 . Zheng X, Nong L, Song Y, Han L, Zhang Y, Yin Q, et al. Comparison of efficacy and safety between aspirin and oral anticoagulants for venous thromboembolism prophylaxis after major orthopaedic surgery: a meta-analysis of randomized clinical trials. Front Pharmacol. 2024;14:1326224. https://doi.org/10.3389/fphar.2023.1326224 . Ye P, Luo Y. Influencing Factors (History of Alcohol Consumption) and Construction of a Nomogram Prediction Model for In-Hospital Gastrointestinal Bleeding Secondary to Acute Cerebral Hemorrhage in a Certain Hospital. Risk Manag Healthc Policy. 2025;18:1557–68. (PMID: 10.2147/RMHP.S5116924037644912080485) Cucca V, Ramirez GA, Pignatti P, Asperti C, Russo M, Della-Torre E, et al. Basal serum diamine oxidase levels as a biomarker of histamine intolerance: a retrospective cohort study. Nutrients. 2022;14(7):1513. https://doi.org/10.3390/nu14071513 . Zhang FF, Lv C, Yang LY, Wang SP, Zhang M, Guo XW. Pharmacokinetics of ropivacaine in elderly patients receiving fascia iliaca compartment block. Experimental Therapeutic Med. 2019;18(4):2648–52. https://doi.org/10.3892/etm.2019.7838 . Kim TJ, Kim ER, Hong SN, Kim Y-H, Lee YC, Kim HS, et al. Effectiveness of acid suppressants and other mucoprotective agents in reducing the risk of occult gastrointestinal bleeding in nonsteroidal anti-inflammatory drug users. Sci Rep. 2019;9(1):11696. https://doi.org/10.1038/s41598-019-48173-6 . Liu F, Li T-T, Yin L, Huang J, Chen Y-J, Xiong L-L, et al. Analgesic effects of sufentanil in combination with flurbiprofen axetil and dexmedetomidine after open gastrointestinal tumor surgery: a retrospective study. BMC Anesthesiol. 2022;22(1):130. https://doi.org/10.1186/s12871-022-01670-0 . Wei L, Shang Y, Liu X, Li X, Chen G, Liang S, et al. Antibody responses and the effects of clinical drugs in COVID-19 patients. Front Immunol. 2021;12:580989. https://doi.org/10.3389/fimmu.2021.580989 . Jiang S, Liu T, Hu Y, Li R, Di X, Jin X, et al. Efficacy and safety of glucocorticoids in the treatment of severe community-acquired pneumonia. Medicine. 2019;98(26):e16239. https://doi.org/10.1097/MD.0000000000016239 . Tamer F, Edek YC, Aksakal AB. Effect of treatment with biologic agents on the novel inflammatory biomarkers systemic immune inflammation index and systemic inflammation response index for psoriasis. Dermatol Pract Concept. 2024;14(1):e2024065. https://doi.org/10.5826/dpc.1401a65 . Liu Z-J, Li G-H, Wang J-X, Mo Z-H, Yang K-Y, Shen C-L, et al. Prognostic value of the systemic immune-inflammation index in critically ill elderly patients with hip fracture: evidence from MIMIC (2008–2019). Front Med. 2024;11:1408371. https://doi.org/10.3389/fmed.2024.1408371 . Murugan SK, Bethapudi B, Raghunandhakumar S, Purusothaman D, Nithyanantham M, Mundkinajeddu D, et al. A flavonoid rich standardized extract of Glycyrrhiza glabra protects intestinal epithelial barrier function and regulates the tight-junction proteins expression. BMC Complement Med Ther. 2022;22(1):38. https://doi.org/10.1186/s12906-021-03500-1 . Ramadanov N, Salzmann M, Voss M, Hable R, Hakam HT, Prill R, et al. The influence of operation time for hip hemiarthroplasty on complication rates and mortality in patients with femoral neck fracture: a retrospective data analysis. J Orthop Surg Res. 2024;19(1):311. (PMID: 10.1186/s13018-024-04797-73880294511129483) Harris T, Segovia N, Koltsov J, Gardner M. Association between operative duration and adverse outcomes after hip fracture surgery: A NSQIP matched cohort study. Injury. 2024;55(8):111635. (PMID: 10.1016/j.injury.2024.11163538852528) Krickl J, Ittermann T, Thannheimer A, Schmidt W, Willauschus M, Ruether J, et al. The rising problem of hip fractures in geriatric patients-analysis of surgical influences on the outcome. J Pers Med. 2023;13(8):1271. https://doi.org/10.3390/jpm13081271 . |
| Contributed Indexing: | Keywords: Elderly patients; Gastrointestinal bleeding; Hip fracture; Machine learning; Prediction model; Risk factors |
| Substance Nomenclature: | 0 (Anti-Inflammatory Agents, Non-Steroidal) |
| Entry Date(s): | Date Created: 20260502 Date Completed: 20260622 Latest Revision: 20260726 |
| Update Code: | 20260726 |
| PubMed Central ID: | PMC13285533 |
| DOI: | 10.1186/s12877-026-07607-3 |
| PMID: | 42070040 |
| Database: | MEDLINE |
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