Measurement properties of comorbidity indices in maternal health research: a systematic review.
Measurement properties of comorbidity indices in maternal health research: a systematic review.
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DOI：
10.1186/s12884-017-1558-3
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发表时间：
2017-11-13
影响因子：
3.1
通讯作者：
Fowler RA
中科院分区：
文献类型：
--
作者：
Aoyama K;D'Souza R;Inada E;Lapinsky SE;Fowler RA
在美国，每1000名活产中有1.2到4.7人患有产妇危重疾病，每100名危重妇女中约有1人死亡。患者的特征和合并症通常被总结为一个指数或分数，用于预测死亡的可能性；然而，大多数这样的指数出现在非怀孕患者群体中。我们试图系统地回顾孕妇健康管理数据集中使用的共病指数，以便批判性地评估她们的测量特性，并为临床医生和孕产妇健康研究人员推荐最佳工具。我们对MEDLINE和EMBASE进行了系统的搜索，以确定分别在1946年和1947年至2017年5月发表的研究，这些研究描述了在孕产妇健康研究领域使用健康管理数据集的共病指数的预测有效性。我们应用了一个方法论的PubMed搜索过滤器来确定每个指数的测量属性的所有研究。我们最初的搜索检索到8944条引文。确定了61篇文章的全文，并对其进行了最终资格评估。最后，保留了两篇符合条件的文章，描述了适用于卫生管理数据的三个共病指数：母亲共病指数、Charlson共病指数和Elixhauser共病指数。这些对已确定指数的研究具有较低的偏倚风险。由于在生成每个指数时缺乏建立共识的既定方法，导致对所有指数的敏感度都不高。只有母亲共病指数是从孕妇和产后妇女队列中具体推导和验证的，使用管理数据集，在预测死亡率方面的相关c统计量为0.675(95%可信区间0.647-0.666)。只有母亲共病指数直接评估了卫生管理数据集中与孕妇相关的测量属性；然而，在发展和验证研究中，它对死亡率的预测能力有限。进一步研究在临床研究中应用这一指标的可行性，以及它在各种卫生管理数据集中的可靠性，将是逐渐有帮助的。在孕期和产后患者中，这一工具和其他用于风险预测和风险调整的工具的演变是正在进行的研究的重要领域。本文的在线版本(10.1186/s12884-0171558-3)包含向授权用户提供的补充材料。
Maternal critical illness occurs in 1.2 to 4.7 of every 1000 live births in the United States and approximately 1 in 100 women who become critically ill will die. Patient characteristics and comorbid conditions are commonly summarized as an index or score for the purpose of predicting the likelihood of dying; however, most such indices have arisen from non-pregnant patient populations. We sought to systematically review comorbidity indices used in health administrative datasets of pregnant women, in order to critically appraise their measurement properties and recommend optimal tools for clinicians and maternal health researchers. We conducted a systematic search of MEDLINE and EMBASE to identify studies published from 1946 and 1947, respectively, to May 2017 that describe predictive validity of comorbidity indices using health administrative datasets in the field of maternal health research. We applied a methodological PubMed search filter to identify all studies of measurement properties for each index. Our initial search retrieved 8944 citations. The full text of 61 articles were identified and assessed for final eligibility. Finally, two eligible articles, describing three comorbidity indices appropriate for health administrative data remained: The Maternal comorbidity index, the Charlson comorbidity index and the Elixhauser Comorbidity Index. These studies of identified indices had a low risk of bias. The lack of an established consensus-building methodology in generating each index resulted in marginal sensibility for all indices. Only the Maternal Comorbidity Index was derived and validated specifically from a cohort of pregnant and postpartum women, using an administrative dataset, and had an associated c-statistic of 0.675 (95% Confidence Interval 0.647–0.666) in predicting mortality. Only the Maternal Comorbidity Index directly evaluated measurement properties relevant to pregnant women in health administrative datasets; however, it has only modest predictive ability for mortality among development and validation studies. Further research to investigate the feasibility of applying this index in clinical research, and its reliability across a variety of health administrative datasets would be incrementally helpful. Evolution of this and other tools for risk prediction and risk adjustment in pregnant and post-partum patients is an important area for ongoing study. The online version of this article (10.1186/s12884-017-1558-3) contains supplementary material, which is available to authorized users.
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