Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
PLoS One. 2013 Jul 26;8(7):e70061. doi: 10.1371/journal.pone.0070061. Print 2013.
Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a significant source of mortality and morbidity worldwide. By analyzing data of the 2010 Nationwide Inpatient Sample from the Agency for Healthcare Research and Quality (AHRQ), we evaluated the predictive accuracy of the AHRQ's 29-comorbidity index with in-hospital death among US adult hospitalizations with a diagnosis of VTE.
We assessed the case-fatality and prevalence of comorbidities among a sample of 153,518 adult hospitalizations with a diagnosis of VTE that comprised 87,605 DVTs and 65,913 PEs (with and without DVT). We estimated adjusted odds ratios and 95% confidence intervals with multivariable logistic regression models by using comorbidities as predictors and status of in-hospital death as an outcome variable. We assessed the c-statistics for the predictive accuracy of the logistic regression models.
In 2010, approximately 41,944 in-hospital deaths (20,212 with DVT and 21,732 with PE) occurred among 770,137 hospitalizations with a diagnosis of VTE. When compared separately to hospitalizations with VTE, DVT, or PE that had no corresponding comorbidities, congestive heart failure, chronic pulmonary disease, coagulopathy, liver disease, lymphoma, fluid and electrolyte disorders, metastatic cancer, other neurological disorders, peripheral vascular disorders, pulmonary circulation disorders, renal failure, solid tumor without metastasis, and weight loss were positively and independently associated with 10%-125% increased likelihoods of in-hospital death. The c-statistic values ranged from 0.776 to 0.802.
The results of this study indicated that comorbidity was associated independently with risk of death among hospitalizations with VTE and among hospitalizations with DVT or PE. The AHRQ 29-comorbidity index provides acceptable to excellent predictive accuracy for in-hospital deaths among adult hospitalizations with VTE and among those with DVT or PE.
静脉血栓栓塞症（VTE）包括深静脉血栓形成（DVT）和肺栓塞（PE），是全球范围内导致死亡和发病的重要原因。通过分析美国医疗保健研究与质量局（AHRQ）的 2010 年全国住院患者样本数据，我们评估了 AHRQ 的 29 项合并症指数在诊断为 VTE 的美国成年住院患者院内死亡中的预测准确性。
我们评估了诊断为 VTE 的 153518 例成年住院患者的病死率和合并症的患病率，其中包括 87605 例 DVT 和 65913 例 PE（有或无 DVT）。我们使用合并症作为预测因子，将院内死亡状态作为结果变量，通过多变量逻辑回归模型估计调整后的优势比和 95%置信区间。我们评估了逻辑回归模型预测准确性的 c 统计量。
2010 年，在诊断为 VTE 的 770137 例住院患者中，约有 41944 例患者发生院内死亡（20212 例 DVT 和 21732 例 PE）。与无相应合并症的 VTE、DVT 或 PE 住院患者相比，充血性心力衰竭、慢性肺部疾病、凝血障碍、肝脏疾病、淋巴瘤、液体和电解质紊乱、转移性癌症、其他神经系统疾病、周围血管疾病、肺循环疾病、肾衰竭、无转移的实体瘤和体重减轻与院内死亡风险增加 10%-125%独立相关。c 统计量值范围为 0.776 至 0.802。
本研究结果表明，合并症与 VTE 住院患者以及 DVT 或 PE 住院患者的死亡风险独立相关。AHRQ 29 项合并症指数对 VTE 住院患者和 DVT 或 PE 住院患者的院内死亡具有可接受至优秀的预测准确性。
