Validation of Risk Score in Predicting Early Readmissions in Decompensated Cirrhotic Patients: A Model Based on the Administrative Database
Validation of Risk Score in Predicting Early Readmissions in Decompensated Cirrhotic Patients: A Model Based on the Administrative Database
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DOI：
10.1002/hep.30274
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发表时间：
2019-08-01
期刊：
影响因子：
13.5
通讯作者：
Abougergi, Marwan S.
中科院分区：
文献类型：
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作者：
Mumtaz, Khalid;Issak, Abdulfatah;Abougergi, Marwan S.
失代偿性肝硬化患者的早期再入院会给医疗保健带来巨大的负担。使用 2013 年和 2014 年全国再入院数据库 (NRD) 进行了一项回顾性队列研究。诊断为肝硬化且至少具有一种失代偿特征的患者被纳入其中。主要成果是开发一个经过验证的早期再入院风险模型。次要结果是研究 30 天全因再入院率和最常见的再入院原因。多变量逻辑回归模型适合识别再入院的预测因素。最后，根据 2013 年 NRD 开发了一个风险模型，即 Mumtaz 再入院风险评分，用于预测 30 天再入院，并在 2014 年 NRD 上进行了验证。总共包括 123,011 名患者。 30天再入院率为27%，其中79.6%的患者因肝脏相关诊断而再入院。年龄 = 3 Elixhauser 评分；存在肝性脑病、腹水、静脉曲张出血、肝细胞癌、腹腔穿刺术或血液透析；和不按医嘱出院是 30 天再入院的独立预测因素。该模型经过验证，能够将失代偿性肝硬化患者分为 30 天再入院风险低 (30%) 的组。结论：三分之一的失代偿性肝硬化患者在出院后 30 天内再次入院。使用基于人口统计、临床特征和干预措施的具有高通用性的简单风险评分模型可以细化高危患者 30 天再入院的预测； Mumtaz 再入院风险评分强调需要采取有针对性的干预措施，以降低该人群的再入院率。
Early readmission in patients with decompensated liver cirrhosis leads to an enormous burden on health care use. A retrospective cohort study using the 2013 and 2014 Nationwide Readmission Database (NRD) was conducted. Patients with a diagnoses of cirrhosis and at least one feature of decompensation were included. The primary outcome was to develop a validated risk model for early readmission. Secondary outcomes were to study the 30-day all-cause readmission rate and the most common reasons for readmission. A multivariable logistic regression model was fit to identify predictors of readmissions. Finally, a risk model, the Mumtaz readmission risk score, was developed for prediction of 30-day readmission based on the 2013 NRD and validated on the 2014 NRD. A total of 123,011 patients were included. The 30-day readmission rate was 27%, with 79.6% of patients readmitted with liver-related diagnoses. Age = 3 Elixhauser score; presence of hepatic encephalopathy, ascites, variceal bleeding, hepatocellular carcinoma, paracentesis, or hemodialysis; and discharge against medical advice were independent predictors of 30-day readmission. This validated model enabled patients with decompensated cirrhosis to be stratified into groups with low (30%) risk of 30-day readmissions. Conclusion: One third of patients with decompensated cirrhosis are readmitted within 30 days of discharge. The use of a simple risk scoring model with high generalizability, based on demographics, clinical features, and interventions, can bring refinement to the prediction of 30-day readmission in high-risk patients; the Mumtaz readmission risk score highlights the need for targeted interventions in order to decrease rates of readmission within this population.