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Comparing Charlson and Elixhauser comorbidity indices with different weightings to predict in-hospital mortality: an analysis of national inpatient data.

比较不同权重的Charlson和Elixhauser合并症指数预测院内死亡率: 对全国住院患者数据的分析。

  • 影响因子:2.26
  • DOI:10.1186/s12913-020-05999-5
  • 作者列表:"Sharma N","Schwendimann R","Endrich O","Ausserhofer D","Simon M
  • 发表时间:2021-01-06
Abstract

BACKGROUND:Understanding how comorbidity measures contribute to patient mortality is essential both to describe patient health status and to adjust for risks and potential confounding. The Charlson and Elixhauser comorbidity indices are well-established for risk adjustment and mortality prediction. Still, a different set of comorbidity weights might improve the prediction of in-hospital mortality. The present study, therefore, aimed to derive a set of new Swiss Elixhauser comorbidity weightings, to validate and compare them against those of the Charlson and Elixhauser-based van Walraven weights in an adult in-patient population-based cohort of general hospitals. METHODS:Retrospective analysis was conducted with routine data of 102 Swiss general hospitals (2012-2017) for 6.09 million inpatient cases. To derive the Swiss weightings for the Elixhauser comorbidity index, we randomly halved the inpatient data and validated the results of part 1 alongside the established weighting systems in part 2, to predict in-hospital mortality. Charlson and van Walraven weights were applied to Charlson and Elixhauser comorbidity indices. Derivation and validation of weightings were conducted with generalized additive models adjusted for age, gender and hospital types. RESULTS:Overall, the Elixhauser indices, c-statistic with Swiss weights (0.867, 95% CI, 0.865-0.868) and van Walraven's weights (0.863, 95% CI, 0.862-0.864) had substantial advantage over Charlson's weights (0.850, 95% CI, 0.849-0.851) and in the derivation and validation groups. The net reclassification improvement of new Swiss weights improved the predictive performance by 1.6% on the Elixhauser-van Walraven and 4.9% on the Charlson weights. CONCLUSIONS:All weightings confirmed previous results with the national dataset. The new Swiss weightings model improved slightly the prediction of in-hospital mortality in Swiss hospitals. The newly derive weights support patient population-based analysis of in-hospital mortality and seek country or specific cohort-based weightings.

摘要

背景: 了解共病措施对患者死亡率的影响对于描述患者健康状况和调整风险和潜在混杂因素至关重要。Charlson和Elixhauser共病指数已用于风险调整和死亡率预测。然而,一组不同的合并症权重可能会提高住院死亡率的预测。因此,本研究旨在得出一套新的瑞士Elixhauser共病权重,以验证和比较基于Charlson和Elixhauser的van Walraven权重,并在基于成人住院患者人群的综合医院队列中进行比较。 方法: 回顾性分析102家瑞士综合医院 (2012-2017) 609万例住院病例的常规资料。为了得出Elixhauser合并症指数的瑞士权重,我们随机将住院患者数据减半,并验证了第1部分的结果以及第2部分建立的权重系统,以预测住院患者死亡率.Charlson和van Walraven权重应用于Charlson和Elixhauser共病指数。使用针对年龄、性别和医院类型调整的广义相加模型进行权重的推导和验证。 结果: 总体而言,Elixhauser指数、瑞士权重的c-统计量 (0.867,95% CI,0.865-0.868) 和van Walraven权重 (0.863,95% CI,0.862-0.864) 比Charlson权重 (0.850,95% CI,0.849-0.851) 具有显著优势并在推导和验证组中。新瑞士权重的净重新分类改进使Elixhauser-van Walraven的预测性能提高了1.6%,Charlson权重提高了4.9%。 结论: 所有权重都证实了以前使用国家数据集的结果。新的瑞士加权模型稍微改进了瑞士医院住院死亡率的预测。新得出的权重支持基于患者人群的住院死亡率分析,并寻求基于国家或特定队列的权重。

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