Development of a Comorbidity Index for Use in Obstetric Patients
Development of a Comorbidity Index for Use in Obstetric Patients
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DOI：
10.1097/aog.0b013e3182a603bb
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发表时间：
2013-11-01
影响因子：
7.2
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中科院分区：
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目的：开发并验证孕产妇合并症指数，以预测严重孕产妇发病率，定义为急性孕产妇终末器官损伤的发生或死亡。方法：数据来自 2000-2007 年医疗补助分析摘录。主要结局定义为产妇在分娩住院期间至产后 30 天发生终末器官损伤或死亡的情况。数据集被随机分为三分之二的开发队列和三分之一的验证队列。使用开发队列，使用逐步选择算法创建预测主要结果的逻辑回归模型，其中包括 24 名候选者的合并症和母亲年龄。最终模型中包含的每个条件都根据其 beta 系数分配一个权重，并用于计算孕产妇合并症指数。 结果：该队列包括 854,823 例完成妊娠，其中 9,901 例 (1.2%) 因主要研究结果而复杂化。得出的评分包括 20 名产妇状况和产妇年龄。对于分数每增加一点，主要结果的优势比为 1.37（95% 置信区间 [CI] 1.35-1.39）。该模型的 c 统计量为 0.657 (95% CI 0.647-0.666)。在预测孕产妇发病率和死亡率方面，得出的评分明显优于现有的合并症指数。 结论：这一新的孕产妇合并症指数为总结孕产妇疾病负担提供了一种简单的衡量方法，可用于流行病学、卫生服务和比较有效性研究。
OBJECTIVE: To develop and validate a maternal comorbidity index to predict severe maternal morbidity, defined as the occurrence of acute maternal end-organ injury, or mortality.METHODS: Data were derived from the Medicaid Analytic eXtract for the years 2000-2007. The primary outcome was defined as the occurrence of maternal end-organ injury or death during the delivery hospitalization through 30 days postpartum. The data set was randomly divided into a two-thirds development cohort and a one-third validation cohort. Using the development cohort, a logistic regression model predicting the primary outcome was created using a stepwise selection algorithm that included 24-candidate comorbid conditions and maternal age. Each of the conditions included in the final model was assigned a weight based on its beta coefficient, and these were used to calculate a maternal comorbidity index.RESULTS: The cohort included 854,823 completed pregnancies, of which 9,901 (1.2%) were complicated by the primary study outcome. The derived score included 20 maternal conditions and maternal age. For each point increase in the score, the odds ratio for the primary outcome was 1.37 (95% confidence interval [CI] 1.35-1.39). The c-statistic for this model was 0.657 (95% CI 0.647-0.666). The derived score performed significantly better than available comorbidity indices in predicting maternal morbidity and mortality.CONCLUSION: This new maternal comorbidity index provides a simple measure for summarizing the burden of maternal illness for use in the conduct of epidemiologic, health services, and comparative effectiveness research.