Jefferson Medical College, Philadelphia, PA 19107, USA.
J Card Fail. 2011 Aug;17(8):649-56. doi: 10.1016/j.cardfail.2011.04.005. Epub 2011 May 31.
This study was undertaken to identify predictors of hospital length of stay (LOS) for heart failure (HF) patients using clinical variables available at the time of admission and hospital characteristics.
A cohort of 70,094 HF patients discharged to home from 246 hospitals participating in the Get With the Guidelines-Heart Failure was analyzed for admission predictors for LOS. The analysis incorporated patient characteristics (PC) first, then added hospital characteristics (HC) followed by standard laboratory evaluations (SL), including troponin and brain natriuretic peptide (BNP). There were 31,995 patients (45.6%) with LOS < 4 days, 26,750 (38.2%) with LOS 4 to 7 days, and 11,349 (16.2%) with LOS > 7 days. Patients with longer LOS had more comorbidities and a higher severity of disease on admission. Overall models explained a modest amount of LOS variation, with an r(2) of 4.8%, with PC responsible for 1.3% of variation and together with SL explained 2.2% of variation. HC did not change the variation.
Based on admission vital signs and BNP levels, patients with longer LOS have more comorbidities and a higher disease severity. The ability to risk stratify for LOS based on patient admission and hospital characteristics is limited.
本研究旨在通过入院时的临床变量和医院特征，确定心力衰竭（HF）患者住院时间（LOS）的预测因素。
对 246 家参与 Get With the Guidelines-Heart Failure 研究的医院出院的 70094 例 HF 患者进行了 LOS 的入院预测因素分析。该分析首先纳入患者特征（PC），然后加入医院特征（HC），接着是标准实验室评估（SL），包括肌钙蛋白和脑利钠肽（BNP）。LOS<4 天的患者有 31995 例（45.6%），LOS 4-7 天的有 26750 例（38.2%），LOS>7 天的有 11349 例（16.2%）。LOS 较长的患者合并症更多，入院时疾病严重程度更高。总体模型解释了 LOS 变化的一部分，r(2)为 4.8%，PC 占变化的 1.3%，与 SL 一起解释了 2.2%的变化。HC 没有改变变化。
基于入院生命体征和 BNP 水平，LOS 较长的患者合并症更多，疾病严重程度更高。基于患者入院和医院特征对 LOS 进行风险分层的能力有限。
