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Creating a Risk Score for Prolonged Length of Stay Following Pediatric Lung Transplants
Michael DiLeo1, Ruhi Thapar1, Ashley Montgomery1
1Department of Student Affairs, Baylor College of Medicine, Houston, Texas, USA.
Insights
This study identified key factors predicting prolonged length of stay (pLOS) after pediatric lung transplantation (LT). A novel risk score helps stratify patients, enabling targeted interventions to improve outcomes in pediatric LT recipients.
Area of Science:
- Transplantation research
- Pediatric surgery
- Health outcomes analysis
Background:
- Prolonged length of stay (pLOS) is a significant concern in pediatric lung transplantation (LT), impacting patient outcomes.
- Limited research exists on predicting pLOS in this specific pediatric population.
- Identifying predictive factors for pLOS is crucial for optimizing care and resource allocation.
Purpose of the Study:
- To identify factors associated with pLOS in pediatric LT recipients.
- To develop a risk score for predicting individual patient risk of pLOS.
- To inform clinical decision-making and potential interventions.
Main Methods:
- Analysis of 733 pediatric LT cases from the OPTN database (2000-2022).
- Utilized LASSO regularization to identify 13 key predictive factors for pLOS.
- Developed a risk score based on the identified variables and their odds ratios.
Main Results:
- Recipient ethnicity, need for life support, and age (2-10 years) were associated with increased pLOS.
- Factors like shorter cold ischemia time, shorter waitlist time, and primary pulmonary hypertension diagnosis were protective.
- The developed risk score effectively stratified patients into low, medium, and high risk groups for pLOS, with mean LOS of 20.60, 22.53, and 36.72 days, respectively.
Conclusions:
- A validated model and risk score can identify pediatric LT patients at high risk for pLOS.
- Early identification allows for targeted interventions on modifiable risk factors before transplantation.
- This approach can help healthcare systems optimize care and improve outcomes for pediatric LT recipients.
Background:
Pediatric lung transplant (LT) outcomes correlate with prolonged length of stay (pLOS), yet a paucity of research exists predicting pLOS in this population. We aim to identify factors associated with pLOS following pediatric LT, and to create a risk score identifying individual patients at increased risk of pLOS.
Methods:
Using the OPTN database, we analyzed 733 pediatric patients who received an LT between January 2000-July 2022. We used LASSO regularization to identify factors predicting pLOS. A risk score was calculated using odds ratios for each variable in the model.
Results:
LASSO was run on 51 factors and identified 13 to be included in the model. The variables with the highest negative impact on LOS were recipient ethnicity (Asian, Native American, Pacific Islanders, or Mixed Race) (OR = 3.187), recipient requiring life support (OR = 2.354), and recipient age 2-10 years old (OR = 2.203). In contrast, low cold ischemia time (OR = 0.562), time on waitlist 21-60 days (OR = 0.284), and diagnosis of primary pulmonary hypertension (OR = 0.307) had protective effects on LOS. Using the risk score, we stratified patients into three equal groups: low (mean LOS = 20.60 days), medium (mean LOS = 22.53 days), and high risk (mean LOS = 36.72 days) of pLOS. The c-statistic for the model was 0.7931 and 0.7757 for the risk score.
Conclusions:
Using this model and risk score, physicians and healthcare systems could identify patients at risk of pLOS and could intervene on preventable variables before transplantation.
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