Endocr Pract. 2018 Jun;24(6):527-541. doi: 10.4158/EP-2018-0035. Epub 2018 Apr 6.
The Diabetes Early Re-admission Risk Indicator (DERRI) was previously developed and internally validated as a tool to predict the risk of all-cause re-admission within 30 days of discharge (30-day re-admission) of hospitalized patients with diabetes. In this study, the predictive performance of the DERRI with and without additional predictors was assessed in an external sample.
We conducted a retrospective cohort study of adult patients with diabetes discharged from two academic medical centers between January 1, 2000 and December 31, 2014. We applied the previously developed DERRI, which includes admission laboratory results, sociodemographics, a diagnosis of certain comorbidities, and recent discharge information, and evaluated the effect of adding metabolic indicators on predictive performance using multivariable logistic regression. Total cholesterol and hemoglobin A1c (A1c) were selected based on clinical relevance and univariate association with 30-day re-admission.
Among 105,974 discharges, 19,032 (18.0%) were followed by 30-day re-admission for any cause. The DERRI had a C-statistic of 0.634 for 30-day re-admission. Total cholesterol was the lipid parameter most strongly associated with 30-day re-admission. The DERRI predictors A1c and total cholesterol were significantly associated with 30-day re-admission; however, their addition to the DERRI did not significantly change model performance (C-statistic, 0.643 [95% confidence interval, 0.638 to 0.647]; P = .92).
Performance of the DERRI in this external cohort was modest but comparable to other re-admission prediction models. Addition of A1c and total cholesterol to the DERRI did not significantly improve performance. Although the DERRI may be useful to direct resources toward diabetes patients at higher risk, better prediction is needed.
A1c = hemoglobin A1c; CI = confidence interval; DERRI = Diabetes Early Re-admission Risk Indicator; GEE = generalized estimating equation; HDL-C = high-density-lipoprotein cholesterol; ICD-9-CM = International Classification of Diseases, Ninth Revision, Clinical Modification; LDL-C = low-density-lipoprotein cholesterol.
糖尿病早期再入院风险指标（DERRI）是先前开发并进行内部验证的一种工具，用于预测患有糖尿病的住院患者出院后 30 天内（30 天再入院）所有原因再入院的风险。在这项研究中，在外部样本中评估了 DERRI 及其附加预测因子的预测性能。
我们对 2000 年 1 月 1 日至 2014 年 12 月 31 日期间从两家学术医疗中心出院的成年糖尿病患者进行了回顾性队列研究。我们应用了先前开发的 DERRI，该指标包括入院实验室结果、社会人口统计学、某些合并症的诊断以及最近的出院信息，并使用多变量逻辑回归评估添加代谢指标对预测性能的影响。总胆固醇和糖化血红蛋白（A1c）是基于临床相关性和与 30 天再入院的单变量关联选择的。
在 105974 次出院中，有 19032 次（18.0%）因任何原因在 30 天内再次入院。DERRI 对 30 天再入院的 C 统计量为 0.634。总胆固醇是与 30 天再入院最密切相关的血脂参数。DERRI 预测因子 A1c 和总胆固醇与 30 天再入院显著相关；然而，将它们添加到 DERRI 中并没有显著改变模型性能（C 统计量为 0.643[95%置信区间为 0.638 至 0.647]；P=.92）。
DERRI 在该外部队列中的表现适中，但与其他再入院预测模型相当。将 A1c 和总胆固醇添加到 DERRI 中并没有显著提高性能。尽管 DERRI 可能有助于将资源用于风险较高的糖尿病患者，但需要更好的预测。
