The Deyo-Charlson and Elixhauser-van Walraven Comorbidity Indices as predictors of mortality in critically ill patients
The Deyo-Charlson and Elixhauser-van Walraven Comorbidity Indices as predictors of mortality in critically ill patients
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DOI：
10.1136/bmjopen-2015-008990
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发表时间：
2015-01-01
期刊：
影响因子：
2.9
通讯作者：
Lee, Jarone
中科院分区：
文献类型：
--
作者：
Ladha, Karim S.;Zhao, Kevin;Lee, Jarone
目的：我们的主要目标是比较Deyo-Charlson共病指数(DCCI)和Elixhauser-van Walraven共病指数(EVCI)在预测重症监护病房(ICU)患者死亡率中的作用。背景：对位于马萨诸塞州波士顿的两个高等教育中心进行的观察性研究。参与者：研究队列包括2007年1月至2012年12月期间12个ICU住院的59 816名患者。主要和次要结果：为了初步分析，使用DCCI和EVCI构建了30、90、180和365天死亡率的接受者操作员特征曲线，并比较了曲线下面积(AUC)。亚组分析在不同类型的ICU中进行。结果：30天时，DCCI与EVCI的AUC分别为0.65(95%可信区间0.65~0.67)和0.66(95%可信区间0.65~0.66)，P=0.02。两项指标的辨别能力在365天内均有改善(DCCI 0.72(95%CI 0.71至0.72)的AUC与EVCI 0.72(95%CI 0.72至0.72)的AUC，p=0.46)。DCCI和EVCI在所有时间点在ICU中的表现相似，除了神经科学ICU，DCCI在所有时间点上都优于EVCI(1年死亡率：AUC0.73(95%CI0.72vs0.68(95%CI0.67vs0.70)，p=0.005)。基本人口学信息的添加没有改变任何评估时间点的结果。结论：DCCI和EVCI在预测危重患者死亡率方面具有可比性。在评估长期结果时，这两个指数的预测能力都增强了。将人口统计数据添加到这两个指数中并不影响这些指数的预测效用。需要进一步的研究来验证我们的发现，并确定这些指标在临床实践中的实用性。
Objectives: Our primary objective was to compare the utility of the Deyo-Charlson Comorbidity Index (DCCI) and Elixhauser-van Walraven Comorbidity Index (EVCI) to predict mortality in intensive care unit (ICU) patients.Setting: Observational study of 2 tertiary academic centres located in Boston, Massachusetts.Participants: The study cohort consisted of 59 816 patients from admitted to 12 ICUs between January 2007 and December 2012.Primary and secondary outcome: For the primary analysis, receiver operator characteristic curves were constructed for mortality at 30, 90, 180, and 365 days using the DCCI as well as EVCI, and the areas under the curve (AUCs) were compared. Subgroup analyses were performed within different types of ICUs. Logistic regression was used to add age, race and sex into the model to determine if there was any improvement in discrimination.Results: At 30 days, the AUC for DCCI versus EVCI was 0.65 (95% CI 0.65 to 0.67) vs 0.66 (95% CI 0.65 to 0.66), p= 0.02. Discrimination improved at 365 days for both indices (AUC for DCCI 0.72 (95% CI 0.71 to 0.72) vs AUC for EVCI 0.72 (95% CI 0.72 to 0.72), p= 0.46). The DCCI and EVCI performed similarly across ICUs at all time points, with the exception of the neurosciences ICU, where the DCCI was superior to EVCI at all time points (1-year mortality: AUC 0.73 (95% CI 0.72 to 0.74) vs 0.68 (95% CI 0.67 to 0.70), p= 0.005). The addition of basic demographic information did not change the results at any of the assessed time points.Conclusions: The DCCI and EVCI were comparable at predicting mortality in critically ill patients. The predictive ability of both indices increased when assessing long-term outcomes. Addition of demographic data to both indices did not affect the predictive utility of these indices. Further studies are needed to validate our findings and to determine the utility of these indices in clinical practice.