EXTERNAL VALIDATION OF THE DIABETES EARLY RE-ADMISSION RISK INDICATOR (DERRI™)
EXTERNAL VALIDATION OF THE DIABETES EARLY RE-ADMISSION RISK INDICATOR (DERRI™)
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DOI：
10.4158/ep-2018-0035
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发表时间：
2018-06-01
影响因子：
4.2
通讯作者：
Golden, Sherita Hill
中科院分区：
文献类型：
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作者：
Rubin, Daniel J.;Recco, Dominic;Golden, Sherita Hill
目的：糖尿病早期再入院风险指标（DERRI（TM））是以前开发和内部验证的一种工具，用于预测住院糖尿病患者出院后30天内（30天再入院）的全因再入院风险。在这项研究中，预测性能的DERRI（TM），并没有额外的预测因素进行了评估，在外部sample.Methods：我们进行了一项回顾性队列研究，从2000年1月1日至2014年12月31日期间出院的两个学术医疗中心的成人糖尿病患者。我们应用了先前开发的DERRI（TM），其中包括入院实验室结果、社会人口统计学、某些合并症的诊断和最近的出院信息，并使用多变量逻辑回归评估了添加代谢指标对预测性能的影响。总胆固醇和血红蛋白A1 c（A1 c）的基础上选择的临床相关性和单变量关联与30天re-admission.Results：在105，974出院，19，032（18.0%）随后30天再入院的任何原因。DERRI（TM）30天再入院的C-统计量为0.634。总胆固醇是与30天再入院最密切相关的血脂参数。DERRI（TM）预测因子A1 c和总胆固醇与30天再入院显著相关;然而，将其加入DERRI（TM）并没有显著改变模型性能（C-统计量，0.643 [95%置信区间，0.638至0.647]; P = 0.92）。在这个外部队列中，DERRI（TM）的表现是适度的，但与其他再入院预测模型相当。在DERRI（TM）中添加Ale和总胆固醇并没有显著改善性能。虽然DERRI（TM）可能有助于将资源导向高风险糖尿病患者，但需要更好的预测。
Objective: The Diabetes Early Re-admission Risk Indicator (DERRI (TM)) was previously developed and internally validated as a tool to predict the risk of allcause re-admission within 30 days of discharge (30-day re-admission) of hospitalized patients with diabetes. In this study, the predictive performance of the DERRI (TM) with and without additional predictors was assessed in an external sample.Methods: We conducted a retrospective cohort study of adult patients with diabetes discharged from two academic medical centers between January 1, 2000 and December 31, 2014. We applied the previously developed DERRI (TM), which includes admission laboratory results, sociodemographics, a diagnosis of certain comorbidities, and recent discharge information, and evaluated the effect of adding metabolic indicators on predictive performance using multivariable logistic regression. Total cholesterol and hemoglobin A1c (A1c) were selected based on clinical relevance and univariate association with 30-day re-admission.Results: Among 105,974 discharges, 19,032 (18.0%) were followed by 30-day re-admission for any cause. The DERRI (TM) had a C-statistic of 0.634 for 30-day re-admission. Total cholesterol was the lipid parameter most strongly associated with 30-day re-admission. The DERRI (TM) predictors A lc and total cholesterol were significantly associated with 30-day re-admission; however, their addition to the DERRI (TM) did not significantly change model performance (C-statistic, 0.643 [95% confidence interval, 0.638 to 0.647]; P = .92).Conclusion: Performance of the DERRI (TM) in this external cohort was modest but comparable to other re-admission prediction models. Addition of Ale and total cholesterol to the DERRI (TM) did not significantly improve performance. Although the DERRI (TM) may be useful to direct resources toward diabetes patients at higher risk, better prediction is needed.