Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA.
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
Dev Med Child Neurol. 2021 Mar;63(3):313-319. doi: 10.1111/dmcn.14759. Epub 2020 Dec 2.
To develop a new comorbidity index for adults with cerebral palsy (CP), the Whitney Comorbidity Index (WCI), which includes relevant comorbidities for this population and better predicts mortality than the Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI).
Data from the Optum Clinformatics Data Mart was used for this retrospective cohort study. Diagnosis codes were used to identify adults aged 18 years or older with CP (n=1511 females, n=1511 males; mean [SD; range] age=48y [19y 2mo; 18-89y]) and all comorbidities in the year 2014. The WCI was developed based on the comorbidities of the CCI and ECI and other relevant comorbidities associated with 2-year mortality using Cox regression and competing risk analysis. The WCI was examined as unweighted (WCI ) and weighted (WCI ). The model fit and discrimination (C-statistic) of each index was assessed using Cox regression.
Twenty-seven comorbidities were included in the WCI; seven new comorbidities that were not part of the CCI or ECI were added. The WCI and WCI showed a better model fit and discrimination for 1- and 2-year mortality compared to the CCI and ECI. The WCI and WCI were strong predictors for 1- and 2-year mortality (C-statistic [95% confidence interval] ranging from 0.81 [0.76-0.85] to 0.88 [0.82-0.94]).
The new WCI, designed to include clinically relevant comorbidities, provides a better model fit and discrimination of mortality for adults with CP.
Common comorbidity indices exclude relevant comorbidities for adults with cerebral palsy (CP). A new comorbidity index for adults with CP was created by harmonizing clinical theory and data-driven methods. The Whitney Comorbidity Index better predicted 1- and 2-year mortality than other commonly used comorbidity indices.
为了开发一种新的脑性瘫痪（CP）成人合并症指数，即惠特尼合并症指数（WCI），该指数纳入了该人群的相关合并症，并比 Charlson 合并症指数（CCI）和 Elixhauser 合并症指数（ECI）更好地预测死亡率。
本回顾性队列研究使用 Optum Clinformatics Data Mart 中的数据。使用诊断代码识别 2014 年患有 CP（女性 1511 例，男性 1511 例；平均[标准差；范围]年龄为 48 岁[19 岁 2 月；18-89 岁]）的 18 岁及以上成年人和当年所有合并症。WCI 是基于 CCI 和 ECI 的合并症以及其他与 2 年死亡率相关的合并症，使用 Cox 回归和竞争风险分析制定的。WCI 被视为未加权（WCI）和加权（WCI）。使用 Cox 回归评估每个指数的模型拟合度和区分度（C 统计量）。
WCI 纳入了 27 种合并症；新增了 7 种不属于 CCI 或 ECI 的新合并症。与 CCI 和 ECI 相比，WCI 和 WCI 对 1 年和 2 年死亡率的模型拟合度和区分度更好。WCI 和 WCI 是 1 年和 2 年死亡率的强有力预测因素（C 统计量[95%置信区间]范围为 0.81[0.76-0.85]至 0.88[0.82-0.94]）。
新的 WCI 旨在纳入临床相关合并症，可为 CP 成人提供更好的死亡率模型拟合度和区分度。
常见的合并症指数排除了 CP 成人的相关合并症。通过协调临床理论和数据驱动方法，为 CP 成人创建了新的合并症指数。惠特尼合并症指数比其他常用合并症指数更好地预测了 1 年和 2 年的死亡率。
