Horne Benjamin D, Budge Deborah, Masica Andrew L, Savitz Lucy A, Benuzillo José, Cantu Gabriela, Bradshaw Alejandra, McCubrey Raymond O, Bair Tami L, Roberts Colleen A, Rasmusson Kismet D, Alharethi Rami, Kfoury Abdallah G, James Brent C, Lappé Donald L
Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT; Department of Biomedical Informatics, University of Utah, Salt Lake City, UT.
Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT.
Am Heart J. 2017 Mar;185:101-109. doi: 10.1016/j.ahj.2016.12.010. Epub 2016 Dec 29.
Improving 30-day readmission continues to be problematic for most hospitals. This study reports the creation and validation of sex-specific inpatient (i) heart failure (HF) risk scores using electronic data from the beginning of inpatient care for effective and efficient prediction of 30-day readmission risk.
HF patients hospitalized at Intermountain Healthcare from 2005 to 2012 (derivation: n=6079; validation: n=2663) and Baylor Scott & White Health (North Region) from 2005 to 2013 (validation: n=5162) were studied. Sex-specific iHF scores were derived to predict post-hospitalization 30-day readmission using common HF laboratory measures and age. Risk scores adding social, morbidity, and treatment factors were also evaluated.
The iHF model for females utilized potassium, bicarbonate, blood urea nitrogen, red blood cell count, white blood cell count, and mean corpuscular hemoglobin concentration; for males, components were B-type natriuretic peptide, sodium, creatinine, hematocrit, red cell distribution width, and mean platelet volume. Among females, odds ratios (OR) were OR=1.99 for iHF tertile 3 vs. 1 (95% confidence interval [CI]=1.28, 3.08) for Intermountain validation (P-trend across tertiles=0.002) and OR=1.29 (CI=1.01, 1.66) for Baylor patients (P-trend=0.049). Among males, iHF had OR=1.95 (CI=1.33, 2.85) for tertile 3 vs. 1 in Intermountain (P-trend <0.001) and OR=2.03 (CI=1.52, 2.71) in Baylor (P-trend < 0.001). Expanded models using 182-183 variables had predictive abilities similar to iHF.
Sex-specific laboratory-based electronic health record-delivered iHF risk scores effectively predicted 30-day readmission among HF patients. Efficient to calculate and deliver to clinicians, recent clinical implementation of iHF scores suggest they are useful and useable for more precise clinical HF treatment.
对于大多数医院而言，降低30天再入院率仍然是个难题。本研究报告了利用住院治疗开始时的电子数据创建和验证特定性别的住院患者（i）心力衰竭（HF）风险评分，以有效且高效地预测30天再入院风险。
对2005年至2012年在山间医疗集团住院的HF患者（推导组：n = 6079；验证组：n = 2663）以及2005年至2013年在贝勒·斯科特与怀特医疗集团（北区）住院的HF患者（验证组：n = 5162）进行了研究。利用常见的HF实验室检测指标和年龄得出特定性别的iHF评分，以预测出院后30天再入院情况。还评估了纳入社会、发病率和治疗因素的风险评分。
女性的iHF模型使用了钾、碳酸氢盐、血尿素氮、红细胞计数、白细胞计数和平均红细胞血红蛋白浓度；男性的模型组成部分为B型利钠肽、钠、肌酐、血细胞比容、红细胞分布宽度和平均血小板体积。在女性中，山间医疗集团验证组中iHF三分位数3与1相比的比值比（OR）为OR = 1.99（95%置信区间[CI] = 1.28，3.08）（三分位数间P趋势 = 0.002），贝勒医疗集团患者的OR为1.29（CI = 1.01，1.66）（P趋势 = 0.049）。在男性中，山间医疗集团三分位数3与1相比iHF的OR为1.95（CI = 1.33，2.85）（P趋势<0.001），贝勒医疗集团的OR为2.03（CI = 1.52, 2.71）（P趋势<0.001）。使用182 - 183个变量的扩展模型具有与iHF相似的预测能力。
基于特定性别实验室检测指标且通过电子健康记录得出的iHF风险评分能有效预测HF患者的30天再入院情况。iHF评分计算效率高且可提供给临床医生，近期在临床中的应用表明它们对于更精确的临床HF治疗有用且可用。
