Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
Epilepsia. 2011 Dec;52(12):2161-7. doi: 10.1111/j.1528-1167.2011.03292.x. Epub 2011 Oct 17.
To develop an epilepsy-specific comorbidity risk adjustment index for mortality outcomes research.
Data were extracted from five linked administrative databases in Calgary, Canada from April 1, 1996 to March 31, 2004. Epilepsy patients were defined using a validated ICD-9-CM- and ICD-10-CA-based case definition. An epilepsy-specific comorbidity index was developed using comorbidities from the Charlson and Elixhauser indexes and other relevant epilepsy comorbidities. In the final model, 14 comorbidities significantly associated with mortality remained and each was assigned a value of 1-6 based on the hazard ratio from the survival analysis. Total prognostic scores were calculated and compared for all subjects using the epilepsy-specific index and the Charlson index. Crude mortality and survival curves of both indices were compared.
We identified 7,253 subjects who met our case definition for epilepsy. The mean age of participants was 38 years (range 0.03-96), and 52% were male. The mortality rate was 7.9%. High rates of chronic pulmonary disease (20.3%), hypertension (19.6%), cerebrovascular disease (13.7%), fracture (12.1%), depression (28.2%), and alcohol abuse (10.1%) were noted. Patients with lower total prognostic scores were more likely to survive than patients with higher scores, using both indices. However, increasing prognostic scores were more strongly associated with reduced survival using the epilepsy-specific index compared to the Charlson index.
A new comorbidity index for epilepsy, designed to include clinically relevant conditions, provided better discrimination of crude mortality in a population-based group of epilepsy patients compared with the Charlson index.
开发一种用于死亡率研究的癫痫特异性合并症风险调整指数。
数据来自加拿大卡尔加里的五个关联行政数据库，时间范围为 1996 年 4 月 1 日至 2004 年 3 月 31 日。癫痫患者的定义采用了经过验证的 ICD-9-CM 和 ICD-10-CA 为基础的病例定义。使用 Charlson 和 Elixhauser 指数中的合并症以及其他相关癫痫合并症，开发了一种癫痫特异性合并症指数。在最终模型中，有 14 种与死亡率显著相关的合并症仍然存在，根据生存分析的风险比，每种合并症的赋值为 1-6。根据癫痫特异性指数和 Charlson 指数，为所有患者计算并比较了总预后评分。比较了两种指数的粗死亡率和生存曲线。
我们确定了符合癫痫病例定义的 7253 名患者。参与者的平均年龄为 38 岁（范围为 0.03-96 岁），52%为男性。死亡率为 7.9%。慢性肺部疾病（20.3%）、高血压（19.6%）、脑血管疾病（13.7%）、骨折（12.1%）、抑郁症（28.2%）和酗酒（10.1%）的发病率较高。使用两种指数，总预后评分较低的患者比评分较高的患者更有可能存活。然而，与 Charlson 指数相比，使用癫痫特异性指数，预后评分的增加与生存率的降低更密切相关。
与 Charlson 指数相比，为包括临床相关疾病而设计的新的癫痫合并症指数，在基于人群的癫痫患者群体中，对粗死亡率的区分能力更强。
