Stratified delirium risk using prescription medication data in a state-wide cohort.
Stratified delirium risk using prescription medication data in a state-wide cohort.
复制标题
DOI：
10.1016/j.genhosppsych.2021.05.001
复制
发表时间：
2021-07
影响因子：
7
通讯作者：
Perlis RH
中科院分区：
文献类型：
--
作者：
McCoy TH Jr;Castro VM;Hart KL;Perlis RH
谵妄是一种与发病率和死亡率增加相关的常见疾病。药物副作用是可改变谵妄风险的可能来源，并提供了改善谵妄预测模型的机会。本研究通过应用先前验证的算法来计算由完整药物清单引起的中枢神经系统不良反应负担，从而表征了谵妄诊断的风险。使用来自马萨诸塞州全付款人索赔数据库的住院成人（18-65岁）患者队列，我们计算出院后的药物负担，并描述在接下来的90天内新编码谵妄诊断的风险。我们将得到的模型应用到一个被搁置的测试队列中。该队列包括62180人，其中1.6%（1019人）有编码谵妄诊断。在训练队列（43,527人）中，药物负担特征与谵妄诊断呈正相关（OR=5.75, 95% CI 4.34-7.63），并且在调整了人口统计学、临床特征、处方药物和抗胆碱能风险评分后，这种相关性仍然存在（aOR=1.95; 1.31-2.92）。在测试队列中，经过训练的模型产生的曲线下面积为0.80（0.78-0.82）。这种表现在不同年龄和性别的亚组中是相似的。汇总脑相关药物的不良反应有助于识别谵妄诊断高风险个体。
Delirium is a common condition associated with increased morbidity and mortality. Medication side effects are a possible source of modifiable delirium risk and provide an opportunity to improve delirium predictive models. This study characterized the risk for delirium diagnosis by applying a previously validated algorithm for calculating central nervous system adverse effect burden arising from a full medication list. Using a cohort of hospitalized adult (age 18-65) patients from the Massachusetts All-Payers Claims Database, we calculated medication burden following hospital discharge and characterized risk of new coded delirium diagnosis over the following 90 days. We applied the resulting model to a held-out test cohort. The cohort included 62,180 individuals of whom 1.6% (1,019) went on to have a coded delirium diagnosis. In the training cohort (43,527 individuals), the medication burden feature was positively associated with delirium diagnosis (OR=5.75, 95% CI 4.34–7.63) and this association persisted (aOR=1.95; 1.31–2.92) after adjusting for demographics, clinical features, prescribed medications, and anticholinergic risk score. In the test cohort, the trained model produced an area under the curve of 0.80 (0.78–0.82). This performance was similar across subgroups of age and gender. Aggregating brain-related medication adverse effects facilitates identification of individuals at high risk of subsequent delirium diagnosis.
登录
查看更多内容
影响因子：
2.1
作者：
Kurisu K;Miyabe D;Furukawa Y;Shibayama O;Yoshiuchi K
通讯作者：
Yoshiuchi K
影响因子：
39
作者：
Hshieh, Tammy T.;Yue, Jirong;Oh, Esther;Puelle, Margaret;Dowal, Sarah;Travison, Thomas;Inouye, Sharon K.
通讯作者：
Inouye, Sharon K.
影响因子：
3.4
作者：
Breitbart, W;Gibson, C;Tremblay, A
通讯作者：
Tremblay, A
影响因子：
38.1
作者：
Fong, Tamara G.;Tulebaev, Samir R.;Inouye, Sharon K.
通讯作者：
Inouye, Sharon K.
影响因子：
38.9
作者：
Dubois, MJ;Bergeron, N;Skrobik, Y
通讯作者：
Skrobik, Y