手部感染患者中Elixhauser合并症指数与Charlson合并症指数预测价值的差异。
Differences in the Predictive value of Elixhauser Comorbidity Index and the Charlson Comorbidity indices in patients with hand infections.
作者信息
Congiusta Dominick V, Amer Kamil M, Otero Katie, Metrione Michael, Merchant Aziz M, Vosbikian Michael, Ahmed Ifran
机构信息
Rutgers New Jersey Medical School Department of Orthopaedics, 140 Bergen Street, ACC D1610, Newark, NJ 07103, USA.
Department of Surgery, Rutgers University, New Jersey Medical School, 140 Bergen Street, D-1610, Newark, NJ 07103, USA.
出版信息
J Clin Orthop Trauma. 2020 Dec 3;16:27-34. doi: 10.1016/j.jcot.2020.12.001. eCollection 2021 May.
PURPOSE
Hand infections are a common source of potentially debilitating morbidity, particularly in patients with comorbid disease. We hypothesize that there is a difference in predictive value between two commonly used comorbidity indices for the prognosis of hand infections, which may have clinical implications in the management of these conditions.
METHODS
The Nationwide Inpatient Sample 2001-2013 database was queried for hand infections using International Classification of Diseases, Ninth Revision codes. The Elixhauser (ECI) and Charlson (CCI) comorbidity scores were calculated based on validated sets of ICD-9 codes. Primary outcomes included mortality, prolonged length of stay (LOS, defined as >95 percentile), discharge destination, and postoperative complications. Indices were compared using receiver operating characteristic (ROC) curves and the areas under the curve (AUC). If confidence intervals overlapped, significance was determined using the DeLong method for correlated ROC curves. This is a validated, non-parametric comparison used for the calculation of the difference between two AUCs.
RESULTS
A weighted total of 1,511,057 patients were included in this study. The majority were Caucasian (57.1%) males (61.4%). Complication rates included 0.9% mortality, 5.3% prolonged length of stay, 25.3% discharges to non-home destinations, and 5.3% post-operative complications. The ECI and CCI each demonstrated good predictive value for mortality, but poor predictive value for non-routine discharge, prolonged LOS, and post-operative complications. There was a significantly increased likelihood of each complication with increasing comorbidity score for both indices, with the greatest odds ratio in the ECI ≥4 cohort.
CONCLUSIONS
The CCI was superior in predicting mortality while the ECI was superior in predicting non-routine discharge, prolonged length of stay, and postoperative complications, but these indices may not be clinically relevant. While both represent good predictive models, a score specifically designed for patients with hand infections may have superior prognostic value.
LEVEL OF EVIDENCE
Level IV.
目的
手部感染是潜在导致机体衰弱的常见病因，尤其是在患有合并症的患者中。我们假设，两种常用的合并症指数对于手部感染预后的预测价值存在差异，这可能对这些病症的管理具有临床意义。
方法
利用国际疾病分类第九版编码，在2001 - 2013年全国住院患者样本数据库中查询手部感染病例。基于经过验证的ICD - 9编码集计算埃利克斯豪泽（ECI）合并症评分和查尔森（CCI）合并症评分。主要结局包括死亡率、住院时间延长（定义为超过第95百分位数）、出院去向以及术后并发症。使用受试者工作特征（ROC）曲线和曲线下面积（AUC）比较各指数。如果置信区间重叠，则使用用于相关ROC曲线的德朗方法确定显著性。这是一种经过验证的非参数比较方法，用于计算两个AUC之间的差异。
结果
本研究共纳入加权后的1,511,057例患者。大多数为白种人（57.1%）男性（61.4%）。并发症发生率包括0.9%的死亡率、5.3%的住院时间延长、25.3%出院至非家庭目的地以及5.3%的术后并发症。ECI和CCI对死亡率均显示出良好的预测价值，但对非常规出院、住院时间延长和术后并发症的预测价值较差。随着两种指数的合并症评分增加，每种并发症的发生可能性均显著增加，在ECI≥4队列中比值比最大。
结论
CCI在预测死亡率方面更优，而ECI在预测非常规出院、住院时间延长和术后并发症方面更优，但这些指数可能与临床无关。虽然两者均代表良好的预测模型，但专门为手部感染患者设计的评分可能具有更高的预后价值。
证据级别
四级。
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