Patient-Reported Outcome Measures Modestly Enhance Prediction of Readmission in Patients with Cirrhosis.
Patient-Reported Outcome Measures Modestly Enhance Prediction of Readmission in Patients with Cirrhosis.
复制标题
DOI：
10.1016/j.cgh.2021.07.032
复制
发表时间：
2022-06
期刊：
影响因子：
--
通讯作者：
Chalasani N
中科院分区：
文献类型：
--
作者：
Orman ES;Ghabril MS;Desai AP;Nephew L;Patidar KR;Gao S;Xu C;Chalasani N
肝硬化患者的再入院率很高，但预测模型并不理想，并且未包括重要的患者报告结果指标 (PROM)。在一个大型前瞻性队列中，我们研究了 PROM 对 30 天再入院预测的影响。我们对 2014 年 6 月至 2020 年 3 月期间入住三级中心的成人肝硬化患者进行了一项前瞻性队列研究。我们收集了临床信息、社会经济状况以及有关功能状态和生活质量的 PROM。我们使用分层竞争风险事件时间分析来检查 PROM 对再入院预测的影响。 654 名患者存活出院，247 名患者 (38%) 在 30 天内再次入院。再入院与脑血管疾病、腹水、既往入院、通过急诊科入院、白蛋白降低、MELD 升高、乘坐公共交通出院以及日常生活基本活动和生活质量活动领域受损独立相关。再入院率的降低与癌症、感染入院、家中儿童以及情绪功能受损有关。与仅包含临床变量的模型相比，添加功能状态和生活质量变量将受试者工作特征曲线下面积 (AUROC) 从 0.72 改善至 0.73 和 0.75，净重分类指数分别为 0.22 和 0.18。与单独的临床变量相比，社会经济变量并没有显着改善预测。与仅使用电子可用变量的模型相比，在通过综合辨别力改进进行检查时，没有任何模型可以改进预测。 PROM 可能会略微增加肝硬化患者 30 天再入院的预测。不良的社会支持和残疾与再入院有关，可能是未来干预措施的高收益目标。
Patients with cirrhosis have high rates of hospital readmission, but prediction models are suboptimal and have not included important patient-reported outcome measures (PROMs). In a large prospective cohort, we examined the impact of PROMs on prediction of 30-day readmissions. We performed a prospective cohort study of adults with cirrhosis admitted to a tertiary center between June 2014 and March 2020. We collected clinical information, socioeconomic status, and PROMs addressing functional status and quality of life. We used hierarchical competing risk time-to-event analysis to examine the impact of PROMs on readmission prediction. 654 patients were discharged alive, and 247 (38%) were readmitted within 30 days. Readmission was independently associated with cerebrovascular disease, ascites, prior hospital admission, admission via the emergency department, lower albumin, higher MELD, discharge with public transportation, and impaired basic activities of daily living and quality of life activity domain. Reduced readmission was associated with cancer, admission for infection, children at home, and impaired emotional function. Compared to a model including only clinical variables, addition of functional status and quality of life variables improved the area under the receiver operating characteristic curve (AUROC) from 0.72 to 0.73 and 0.75, with net reclassification indices of 0.22 and 0.18, respectively. Socioeconomic variables did not significantly improve prediction compared to clinical variables alone. Compared to a model using electronically-available variables only, no models improved prediction when examined with integrated discrimination improvement. PROMs may marginally add to the prediction of 30-day readmissions for patients with cirrhosis. Poor social support and disability are associated with readmissions and may be high-yield targets for future interventions.
登录
查看更多内容
影响因子：
6.3
作者：
Albrecht JS;Gruber-Baldini AL;Hirshon JM;Brown CH;Goldberg R;Rosenberg JH;Comer AC;Furuno JP
通讯作者：
Furuno JP
影响因子：
13.5
作者：
Mumtaz, Khalid;Issak, Abdulfatah;Abougergi, Marwan S.
通讯作者：
Abougergi, Marwan S.
影响因子：
3.1
作者：
Corey, Kathleen E.;Kartoun, Uri;Shaw, Stanley Y.
通讯作者：
Shaw, Stanley Y.
DOI：
10.1002/hep.28414
发表时间：
2016-07
期刊：
Hepatology (Baltimore, Md.)
影响因子：
--
作者：
Bajaj JS;Reddy KR;Tandon P;Wong F;Kamath PS;Garcia-Tsao G;Maliakkal B;Biggins SW;Thuluvath PJ;Fallon MB;Subramanian RM;Vargas H;Thacker LR;O'Leary JG;North American Consortium for the Study of End-Stage Liver Disease
通讯作者：
North American Consortium for the Study of End-Stage Liver Disease
影响因子：
5.7
作者：
JETTE, AM;DAVIES, AR;DELBANCO, TL
通讯作者：
DELBANCO, TL