使用并发症统计建模来预测住院患者的死亡率:了解住院患者的负担
Hezborn M Magacha1, Sheryl M Strasser2, Shimini Zheng3
1Internal Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, USA.
Cureus
|October 27, 2023
概括
这项研究调整了查尔森并发症指数 (CCI),以使用2020年美国数据预测住院患者的一年死亡率. 严重的肝病,急性心肌梗塞和营养不良是住院患者死亡率的关键预测因素.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 流行病学 流行病学
- 生物统计学 生物统计学
背景情况:
- 美国的医疗保健支出是全球最高的.
- 评估与死亡率相关的住院疾病分类有助于风险分层和了解慢性疾病.
- 预测死亡率对于资源分配和改善患者结果至关重要.
研究的目的:
- 为2020年国家住院样本 (NIS) 数据库适应查尔森并发症指数 (CCI) 模型.
- 用国际疾病分类第10版 (ICD-10) 代码预测成年住院患者的一年死亡率.
- 确定关键的慢性疾病和与住院患者死亡率相关的风险因素.
主要方法:
- 来自2020年NIS数据库的5,533,477名成年住院患者的回顾性队列研究.
- 使用查尔森并发症指数 (CCI) 模型和多变量逻辑回归.
- 在一个子样本 (n=100,000) 上采用倒退阶段物流回归,以确定死亡率的显著预测因素.
主要成果:
- 贫血,肺部疾病 (包括COPD) 和糖尿病在住院患者中最为普遍.
- 严重的肝病/肝衰竭 (aOR 10.50),急性心肌梗塞 (aOR 2.85),和营养不良 (aOR 2.15) 是住院患者死亡率的最强预测因素.
- 最终的模型实现了0.752.75的统计一致率 (AUC).
结论:
- 调整后的CCI模型有效地对住院患者与死亡风险相关的发病率进行了分类.
- 结果提供了一个客观的方法来比较患者群体和改善医疗保健系统.
- 结果对治疗方法,护理模式和预防策略有影响,以提高患者的治疗结果.
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