A new Elixhauser-based comorbidity summary measure to predict in-hospital mortality.
A new Elixhauser-based comorbidity summary measure to predict in-hospital mortality.
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DOI：
10.1097/mlr.0000000000000326
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发表时间：
2015-04
期刊：
影响因子：
3
通讯作者：
Griffith SD
中科院分区：
文献类型：
--
作者：
Thompson NR;Fan Y;Dalton JE;Jehi L;Rosenbaum BP;Vadera S;Griffith SD
最近，货车Walraven根据Elixhauser合并症系统中的30种合并症开发了加权汇总评分（VW）。30种合并症之一，心律失常，目前被排除在管理数据集中作为合并症指标，如全国住院患者样本（NIS），促使我们检查VW评分的有效性及其在NIS中的使用。使用2009年马里兰州住院患者数据库的数据，我们推导出加权汇总评分，以预测基于完整（30）和简化（29）合并症的住院死亡率，并比较这些和2009年NIS数据中其他合并症汇总的模型性能。我们推导出的评分的权重对排除心律失常不敏感。当应用于NIS数据时，包含衍生汇总评分的模型与使用所有29个合并症指标的模型（c = 0.809）表现几乎相同（30和29个变量衍生汇总评分的c统计量分别为0.804和0.802），略优于VW评分（c = 0.793）。这些模型中的每一个模型的性能均显著优于基于Elixhauser合并症简单计数（c = 0.745）或分类计数（0、1、2或≥3种合并症; c = 0.737）的模型。VW评分和我们推导的评分在NIS中有效，并且在统计学上上级使用简单共病计数的总结。希望用单一值总结Elixhauser合并症的研究者应使用VW评分或本研究中得出的评分。
Recently, van Walraven developed a weighted summary score (VW) based on the 30 comorbidities from the Elixhauser comorbidity system. One of the 30 comorbidities, cardiac arrhythmia, is currently excluded as a comorbidity indicator in administrative datasets such as the Nationwide Inpatient Sample (NIS), prompting us to examine the validity of the VW score and its use in the NIS. Using data from the 2009 Maryland State Inpatient Database, we derived weighted summary scores to predict in-hospital mortality based on the full (30) and reduced (29) set of comorbidities and compared model performance of these and other comorbidity summaries in 2009 NIS data. Weights of our derived scores were not sensitive to the exclusion of cardiac arrhythmia. When applied to NIS data, models containing derived summary scores performed nearly identically (c statistics for 30 and 29 variable-derived summary scores: 0.804 and 0.802, respectively) to the model using all 29 comorbidity indicators (c = 0.809), and slightly better than the VW score (c = 0.793). Each of these models performed substantially better than those based on a simple count of Elixhauser comorbidities (c = 0.745) or a categorized count (0, 1, 2, or ≥3 comorbidities; c = 0.737). The VW score and our derived scores are valid in the NIS and are statistically superior to summaries using simple co-morbidity counts. Researchers wishing to summarize the Elixhauser comorbidities with a single value should use the VW score or those derived in this study.