Development and Validation of a Comorbidity Scoring System for Patients With Cirrhosis
Development and Validation of a Comorbidity Scoring System for Patients With Cirrhosis
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DOI：
10.1053/j.gastro.2013.09.019
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发表时间：
2014-01-01
期刊：
影响因子：
29.4
通讯作者：
Lash, Timothy L.
中科院分区：
文献类型：
--
作者：
Jepsen, Peter;Vilstrup, Hendrik;Lash, Timothy L.
背景与目的：至少40%的肝硬化患者伴有增加死亡率的合并症。我们开发了一种针对肝硬化的合并症评分系统（CirCom），以帮助确定这些合并症如何影响死亡率，并将其与通用的查尔森合并症指数进行比较。
方法：我们使用来自全国医疗登记处的数据，确定了1999 - 2008年被诊断为肝硬化的丹麦公民（n = 12,976）。对他们随访至2010年，并记录了34种合并症。我们使用考克斯回归为调整后死亡风险比（HR）≥1.20的合并症赋予严重程度权重。每位患者的CirCom评分最多基于其中2种合并症。通过哈雷尔C统计量和净重分类指数（NRI）评估性能，并将结果与使用查尔森指数（基于17种合并症）获得的结果进行比较。在2个独立的酒精相关性肝硬化或慢性丙型肝炎患者队列中对研究结果进行验证。
结果：CirCom评分包括慢性阻塞性肺疾病、急性心肌梗死、外周动脉疾病、癫痫、药物滥用、心力衰竭、非转移性癌症、转移性癌症和慢性肾脏病；24.2%的患者患有其中1种或多种疾病，且死亡率与CirCom评分相关。患者的CirCom评分与他们的查尔森合并症指数相关（肯德尔τ = 0.57；P <.0001）。与查尔森指数相比，CirCom评分使哈雷尔C统计量提高了0.6%（95%置信区间：0.3% - 0.8%）。CirCom评分的NRI为5.2%（95%置信区间：3.7% - 6.9%），查尔森指数的NRI为3.6%（95%置信区间：2.3% - 5.0%）。在验证队列中获得了类似的结果。
结论：我们开发了一种基于9种合并症预测肝硬化患者死亡率的评分系统。该系统比查尔森合并症指数具有更高的C统计量和NRI值，且更易于使用。因此，它可能是预测患者死亡或生存以及用于流行病学研究的首选方法。
BACKGROUND & AIMS: At least 40% of patients with cirrhosis have comorbidities that increase mortality. We developed a cirrhosis-specific comorbidity scoring system (CirCom) to help determine how these comorbidities affect mortality and compared it with the generic Charlson Comorbidity Index. METHODS: We used data from nationwide health care registries to identify Danish citizens diagnosed with cirrhosis in 1999-2008 (n = 12,976). They were followed through 2010 and characterized by 34 comorbidities. We used Cox regression to assign severity weights to comorbidities with an adjusted mortality hazard ratio (HR) >= 1.20. Each patient's CirCom score was based on, at most, 2 of these comorbidities. Performance was measured with Harrell's C statistic and the Net Reclassification Index (NRI) and results were compared with those obtained using the Charlson Index (based on 17 comorbidities). Findings were validated in 2 separate cohorts of patients with alcohol-related cirrhosis or chronic hepatitis C. RESULTS: The CirCom score included chronic obstructive pulmonary disease, acute myocardial infarction, peripheral arterial disease, epilepsy, substance abuse, heart failure, non-metastatic cancer, metastatic cancer, and chronic kidney disease; 24.2% of patients had 1 or more of these, and mortality correlated with the CirCom score. Patients' CirCom score correlated with their Charlson Comorbidity Index (Kendall's tau = 0.57; P < .0001). Compared with the Charlson Index, the CirCom score increased Harrell's C statistic by 0.6% (95% confidence interval: 0.3%-0.8%). The NRI for the CirCom score was 5.2% (95% confidence interval: 3.7%-6.9%), and the NRI for the Charlson Index was 3.6% (95% confidence interval: 2.3%-5.0%). Similar results were obtained from the validation cohorts. CONCLUSIONS: We developed a scoring system to predict mortality among patients with cirrhosis based on 9 comorbidities. This system had higher C statistic and NRI values than the Charlson Comorbidity Index, and is easier to use. It could therefore be a preferred method to predict death or survival of patients and for use in epidemiologic studies.