{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T11:26:28Z","timestamp":1788780388141,"version":"build-2803163510"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T00:00:00Z","timestamp":1747180800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Microbiol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The annual incidence of upper gastrointestinal hemorrhage (UGIB) is about 60 cases\/100,000 people, and about 40% of UGIB patients have hemorrhagic ulcers. Ulcer formation is often associated with <jats:italic>Helicobacter pylori<\/jats:italic> (<jats:italic>H. pylori<\/jats:italic>) infection, non-steroidal anti-inflammatory drugs (NSAIDs) use and other factors, so ulcerative disease is the main cause of upper gastrointestinal bleeding. <jats:italic>H. pylori<\/jats:italic> induces chronic superficial gastritis with neutrophils infiltrating into the mucosa, so it is assumed that <jats:italic>H. pylori<\/jats:italic> infection is the basis of bleeding lesions. <jats:italic>H. pylori<\/jats:italic> infection is widespread worldwide, with about 50% of the population carrying the bacteria. Mortality during hospitalization is higher in patients with UGIB because rebleeding significantly increases the risk of death, especially if timely intervention is not provided. Rebleeding may also lead to severe complications such as shock and multiple organ failure. At present, the commonly used clinical scores for UGIB patients mainly include Rockall score (RS), AIMS65 score and Glasgow-Blatchford score (GBS). Because some hospitals are limited by local medical and health conditions, they lack timely and accurate endoscopic diagnosis and treatment equipment, and it is difficult to make accurate and timely judgments on patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>In this experiment, 254 patients with upper digestive tract hemorrhage from Shengjing Hospital affiliated to China Medical University were collected, and the clinical indicators and information of <jats:italic>H. pylori<\/jats:italic> infection, age, shock state, concomitant disease, <jats:italic>H. pylori<\/jats:italic> infection degree, systolic blood pressure, blood urea nitrogen, hemoglobin, pulse, black stool, syncope, liver disease and other patients were finally collected. We analyzed the correlation between various clinical indicators and rebleeding in hospitalized patients. Based on the collected clinical information and laboratory indicators, this study constructed a deep learning model, the data is divided into four categories (clinical information, vital signs, laboratory examination items, stool examination) as input, and Transformer is used as feature extractor. KAN as a classifier to predict the risk of rebleeding in patients with upper gastrointestinal bleeding. The model uses five-fold cross validation and calculates key metrics such as accuracy to evaluate its performance. In addition, the deep learning model was compared with a variety of machine learning methods (decision tree, random forest, logistic regression, K-nearest neighbor) and common clinical risk scores (Rockall score, AIMS65 score, Glasgow-Blatchford score) to verify its effectiveness and advantages. In order to highlight the importance of <jats:italic>H. pylori<\/jats:italic> infection degree to the model performance, we conducted a comparative experiment to observe the role of <jats:italic>H. pylori<\/jats:italic> infection degree in the model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the correlation analysis between rebleeding and clinical data and related indicators, the risk of rebleeding in men (62.5%) was higher than that in women (43.47%), and the risk of rebleeding in patients with concurrent diseases (60.37%) was higher than that in patients without concurrent diseases. In the analysis of the correlation between the degree of infection and the laboratory test items, the hemoglobin level of patients will also change with the change of the degree of infection of patients (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.05 in the above correlation analysis, all had statistical significance). The rebleeding detection rates of Rockall score, AIMS65 score and Glasgow Blatchford score were 16.14%, 0 and 77.17%, respectively. Of the four machine learning models, Random Forest (RF) had the highest accuracy on the test set at 0.68. The accuracy of the deep learning model on the verification set is the highest of 0.9750, and the accuracy of the test set is the highest of 0.9615. In addition, by exploring the influence of infection on the model prediction, it was found that the prediction accuracy of rebleeding in the non-<jats:italic>H. pylori<\/jats:italic> infection group (0.8989) was lower than that in the <jats:italic>H. pylori<\/jats:italic> infection group (0.9636), and other evaluation parameters were also lower than that in the infection group. In addition, by adding irrelevant random noise to mask the influence of infection degree on model output, it is found that the model prediction accuracy (0.7992) is significantly reduced.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Based on the degree of <jats:italic>H. pylori<\/jats:italic> infection in patients with upper gastrointestinal bleeding, combined with a number of clinical laboratory tests and clinical data, we developed a clinical model for predicting the risk of rebleeding in patients with upper gastrointestinal bleeding. It provides an early prediction of rebleeding during a patient\u2019s hospitalization and optimizes early intervention for patients to a certain extent. It provides a more concise, convenient and effective guidance scheme for small and medium-sized hospitals to make clinical decisions for UGIB patients.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmicb.2025.1510126","type":"journal-article","created":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T05:38:46Z","timestamp":1747201126000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Construction of a predictive model for rebleeding risk in upper gastrointestinal bleeding patients based on clinical indicators such as Helicobacter pylori infection"],"prefix":"10.3389","volume":"16","author":[{"given":"Wei","family":"Zang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ze","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanduo","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianshi","family":"Jia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinglong","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,5,14]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1080\/17474124.2023.2242252","article-title":"Strengths and limitations of risk stratification tools for patients with upper gastrointestinal bleeding: a narrative review","volume":"17","author":"Alali","year":"2023","journal-title":"Expert Rev. Gastroenterol. Hepatol."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1318","DOI":"10.1016\/S0140-6736(00)02816-6","article-title":"A risk score to predict need for treatment for upper-gastrointestinal haemorrhage","volume":"356","author":"Blatchford","year":"2000","journal-title":"Lancet"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"CD002042","DOI":"10.1002\/14651858.CD002042.pub5","article-title":"Transfusion thresholds for guiding red blood cell transfusion","volume":"2022","author":"Carson","year":"2021","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1188","DOI":"10.3390\/diagnostics13061188","article-title":"The accuracy of pre-endoscopic scores for mortality prediction in patients with upper GI bleeding and no endoscopy performed","volume":"13","author":"Cazacu","year":"2023","journal-title":"Diagnostics"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e11656","DOI":"10.7717\/peerj.11656","article-title":"Prediction model of emergency mortality risk in patients with acute upper gastrointestinal bleeding: a retrospective study","volume":"9","author":"Chen","year":"2021","journal-title":"PeerJ"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"771","DOI":"10.1055\/a-1731-9535","article-title":"A deep learning-based system for real-time image reporting during esophagogastroduodenoscopy: a multicenter study","volume":"54","author":"Dong","year":"2022","journal-title":"Endoscopy"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1856","DOI":"10.3390\/jpm12111856","article-title":"Transarterial embolization for active gastrointestinal bleeding: predictors of early mortality and early Rebleeding","volume":"12","author":"Extrat","year":"2022","journal-title":"J Personal Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1170","DOI":"10.3390\/life14091170","article-title":"Advances in diagnostic modalities for Helicobacter pylori infection","volume":"14","author":"Ghazanfar","year":"2024","journal-title":"Life"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1055\/a-1369-5274","article-title":"Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) guideline\u2014update 2021","volume":"53","author":"Gralnek","year":"2021","journal-title":"Endoscopy"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"612","DOI":"10.1093\/ajcp\/aqad088","article-title":"Helicobacter pylori-negative mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach: a clinicopathologic analysis","volume":"160","author":"Gu","year":"2023","journal-title":"Am. J. Clin. Pathol."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e13220","DOI":"10.1111\/nmo.13220","article-title":"Gastric myoelectrical and neurohormonal changes associated with nausea during tilt-induced syncope","volume":"30","author":"Heyer","year":"2018","journal-title":"Neurogastroenterol Motil"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"2819","DOI":"10.1111\/jgh.15555","article-title":"Which scoring system should be used for non-variceal upper gastrointestinal bleeding? Old or new?","volume":"36","author":"Jeon","year":"2021","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1016\/j.mayocp.2019.01.022","article-title":"Upper gastrointestinal bleeding: etiologies and management","volume":"94","author":"Kamboj","year":"2019","journal-title":"Mayo Clin. Proc."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"E990","DOI":"10.1055\/a-1187-1154","article-title":"Endoscopic treatment of variceal upper gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) Cascade guideline","volume":"8","author":"Karstensen","year":"2020","journal-title":"Endosc Int Open"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"11351","DOI":"10.1038\/s41598-023-38206-6","article-title":"Deep learning model for distinguishing Mayo endoscopic subscore 0 and 1 in patients with ulcerative colitis","volume":"13","author":"Kim","year":"2023","journal-title":"Sci. Rep."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"e221257","DOI":"10.1148\/radiol.221257","article-title":"Deep learning image reconstruction for CT: technical principles and clinical prospects","volume":"306","author":"Koetzier","year":"2023","journal-title":"Radiology"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"13","DOI":"10.4103\/sjg.SJG_152_20","article-title":"Restrictive versus liberal transfusion strategy in upper gastrointestinal bleeding: a randomized controlled trial","volume":"27","author":"Kola","year":"2021","journal-title":"Saudi J. Gastroenterol."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"899","DOI":"10.14309\/ajg.0000000000001245","article-title":"ACG clinical guideline: upper gastrointestinal and ulcer bleeding","volume":"116","author":"Laine","year":"2021","journal-title":"Am. J. Gastroenterol."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1190","DOI":"10.1038\/ajg.2012.168","article-title":"Trends for incidence of hospitalization and death due to GI complications in the United States from 2001 to 2009","volume":"107","author":"Laine","year":"2012","journal-title":"Am. J. Gastroenterol."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1633","DOI":"10.1038\/ajg.2009.164","article-title":"Time trends and impact of upper and lower gastrointestinal bleeding and perforation in clinical practice","volume":"104","author":"Lanas","year":"2009","journal-title":"Am. J. Gastroenterol."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1038\/nature14539","article-title":"Deep learning","volume":"521","author":"LeCun","year":"2015","journal-title":"Nature"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"54","DOI":"10.17235\/reed.2023.9645\/2023","article-title":"An unusual cause of life-threatening upper gastrointestinal bleeding","volume":"116","author":"Li","year":"2024","journal-title":"Rev. Esp. Enferm. Dig."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"22800","DOI":"10.1038\/s41598-023-50266-2","article-title":"A pilot study of non-invasive diagnostic tools to detect Helicobacter pylori infection and peptic ulcer disease","volume":"13","author":"Liao","year":"2023","journal-title":"Sci. Rep."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"758","DOI":"10.1007\/s00535-021-01797-w","article-title":"A simple prediction score for in-hospital mortality in patients with nonvariceal upper gastrointestinal bleeding","volume":"56","author":"Matsuhashi","year":"2021","journal-title":"J. Gastroenterol."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1147","DOI":"10.3892\/etm.2021.10582","article-title":"Role of Helicobacter pylori in the triggering and evolution of hemorrhagic gastro-duodenal lesions","volume":"22","author":"Popa","year":"2021","journal-title":"Exp. Ther. Med."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"e000685","DOI":"10.1136\/bmjgast-2021-000685","article-title":"Cost-effectiveness modelling of use of urea breath test for the management of Helicobacter pylori-related dyspepsia and peptic ulcer in the UK","volume":"8","author":"Pritchard","year":"2021","journal-title":"BMJ Open Gastroenterol."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1111\/jgh.14811","article-title":"MAP(ASH): a new scoring system for the prediction of intervention and mortality in upper gastrointestinal bleeding","volume":"35","author":"Redondo-Cerezo","year":"2020","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1136\/gut.38.3.316","article-title":"Risk assessment after acute upper gastrointestinal haemorrhage","volume":"38","author":"Rockall","year":"1996","journal-title":"Gut"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1215","DOI":"10.1016\/j.gie.2011.06.024","article-title":"A simple risk score accurately predicts in-hospital mortality, length of stay, and cost in acute upper GI bleeding","volume":"74","author":"Saltzman","year":"2011","journal-title":"Gastrointest. Endosc."},{"key":"ref31","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1016\/j.neunet.2014.09.003","article-title":"Deep learning in neural networks: an overview","volume":"61","author":"Schmidhuber","year":"2015","journal-title":"Neural Netw."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"2603","DOI":"10.3390\/jcm9082603","article-title":"Prediction of adverse events in stable non-variceal gastrointestinal bleeding using machine learning","volume":"9","author":"Seo","year":"2020","journal-title":"J. Clin. Med."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1053\/j.gastro.2019.09.009","article-title":"Validation of a machine learning model that outperforms clinical risk scoring Systems for Upper Gastrointestinal Bleeding","volume":"158","author":"Shung","year":"2020","journal-title":"Gastroenterology"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"1062","DOI":"10.1111\/apt.17949","article-title":"Review article: upper gastrointestinal bleeding\u2014review of current evidence and implications for management","volume":"59","author":"Shung","year":"2024","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref35","doi-asserted-by":"publisher","first-page":"2827","DOI":"10.1080\/02640414.2018.1478612","article-title":"Does biological sex impact intestinal epithelial injury, small intestine permeability, gastrointestinal symptoms and systemic cytokine profile in response to exertional-heat stress?","volume":"36","author":"Snipe","year":"2018","journal-title":"J. Sports Sci."},{"key":"ref36","doi-asserted-by":"publisher","first-page":"l536","DOI":"10.1136\/bmj.l536","article-title":"Management of acute upper gastrointestinal bleeding","volume":"364","author":"Stanley","year":"2019","journal-title":"BMJ"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"i6432","DOI":"10.1136\/bmj.i6432","article-title":"Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study","volume":"356","author":"Stanley","year":"2017","journal-title":"BMJ"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"17562848231190970","DOI":"10.1177\/17562848231190970","article-title":"At admission hemodynamic instability is associated with increased mortality and rebleeding rate in acute gastrointestinal bleeding: a systematic review and meta-analysis","volume":"16","author":"Tari","year":"2023","journal-title":"Ther. Adv. Gastroenterol."},{"key":"ref39","doi-asserted-by":"publisher","first-page":"e14061","DOI":"10.7717\/peerj.14061","article-title":"Cancer, platelet distribution width, and total protein levels as predictors of rebleeding in upper gastrointestinal bleeding","volume":"10","author":"Tatl\u0131parmak","year":"2022","journal-title":"PeerJ"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"706","DOI":"10.1111\/apt.18485","article-title":"Blood group B may reduce risk of Rebleeding in patients with upper gastrointestinal Haemorrhage due to peptic ulcer disease","volume":"61","author":"Taylor","year":"2025","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref41","doi-asserted-by":"publisher","first-page":"17301","DOI":"10.1038\/s41598-023-44271-8","article-title":"Potential benefits of restrictive transfusion in upper gastrointestinal bleeding: a systematic review and meta-analysis of randomised controlled trials","volume":"13","author":"Teutsch","year":"2023","journal-title":"Sci. Rep."},{"key":"ref42","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1186\/s13049-017-0425-6","article-title":"Management of upper gastrointestinal bleeding in emergency departments, from bleeding symptoms to diagnosis: a prospective, multicenter, observational study","volume":"25","author":"Thiebaud","year":"2017","journal-title":"Scand. J. Trauma Resusc. Emerg. Med."},{"key":"ref43","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1136\/bmjebm-2024-112886","article-title":"Pharmacological interventions for preventing upper gastrointestinal bleeding in people admitted to intensive care units: a network meta-analysis","volume":"30","author":"Toews","year":"2024","journal-title":"BMJ Evid Based Med"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1007\/s00414-021-02721-w","article-title":"Case report: fatal bleeding from a duodenal ulcer-Dieulafoy\u2019s lesion?","volume":"136","author":"Ulbricht","year":"2022","journal-title":"Int. J. Legal Med."},{"key":"ref45","doi-asserted-by":"publisher","first-page":"1134835","DOI":"10.3389\/fmed.2023.1134835","article-title":"Predicting mortality in patients with nonvariceal upper gastrointestinal bleeding using machine-learning","volume":"10","author":"Ungureanu","year":"2023","journal-title":"Front. Med."},{"key":"ref46","doi-asserted-by":"publisher","first-page":"147","DOI":"10.14744\/tjtes.2021.00670","article-title":"Features of patients with upper gastrointestinal bleeding and factors affecting the re-bleeding risk","volume":"28","author":"Uysal","year":"2021","journal-title":"Turk J Trauma Emerg Surg"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"5893","DOI":"10.3390\/jcm11195893","article-title":"A novel prediction tool for endoscopic intervention in patients with acute upper gastro-intestinal bleeding","volume":"11","author":"Veisman","year":"2022","journal-title":"J. Clin. Med."},{"key":"ref48","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1016\/j.gie.2023.02.025","article-title":"Effect of a deep learning-based automatic upper GI endoscopic reporting system: a randomized crossover study (with video)","volume":"98","author":"Zhang","year":"2023","journal-title":"Gastrointest. Endosc."},{"key":"ref49","doi-asserted-by":"publisher","first-page":"1035","DOI":"10.1111\/jgh.14548","article-title":"Analysis of risk factors and development of scoring system to predict severity of upper gastrointestinal bleeding in children","volume":"34","author":"Zheng","year":"2019","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref50","doi-asserted-by":"publisher","first-page":"1543","DOI":"10.1111\/apt.17238","article-title":"Trends in characteristics, management, and outcomes of patients presenting with gastrointestinal bleeding to emergency departments in the United States from 2006 to 2019","volume":"56","author":"Zheng","year":"2022","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref51","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1080\/17474124.2022.2020646","article-title":"Application and prospect of artificial intelligence in digestive endoscopy","volume":"16","author":"Zhuang","year":"2022","journal-title":"Expert Rev. Gastroenterol. Hepatol."},{"key":"ref52","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1186\/s40001-023-01349-3","article-title":"Construction of a prediction model for rebleeding in patients with acute upper gastrointestinal bleeding","volume":"28","author":"Zhuang","year":"2023","journal-title":"Eur. J. Med. 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