MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.
CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal.
J Med Syst. 2022 May 6;46(6):37. doi: 10.1007/s10916-022-01805-3.
The aims of this study were to assess All-Patient Refined Diagnosis-Related Groups' (APR-DRG) Severity of Illness (SOI) and Risk of Mortality (ROM) as predictors of in-hospital mortality, comparing with Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI) scores. We performed a retrospective observational study using mainland Portuguese public hospitalizations of adult patients from 2011 to 2016. Model discrimination (C-statistic/ area under the curve) and goodness-of-fit (R-squared) were calculated. Our results comprised 4,176,142 hospitalizations with 5.9% in-hospital deaths. Compared to the CCI and ECI models, the model considering SOI, age and sex showed a statistically significantly higher discrimination in 49.6% (132 out of 266) of APR-DRGs, while in the model with ROM that happened in 33.5% of APR-DRGs. Between these two models, SOI was the best performer for nearly 20% of APR-DRGs. Some particular APR-DRGs have showed good discrimination (e.g. related to burns, viral meningitis or specific transplants). In conclusion, SOI or ROM, combined with age and sex, perform better than more widely used comorbidity indices. Despite ROM being the only score specifically designed for in-hospital mortality prediction, SOI performed better. These findings can be helpful for hospital or organizational models benchmarking or epidemiological analysis.
本研究旨在评估所有患者细化诊断相关组（APR-DRG）的疾病严重程度（SOI）和死亡率风险（ROM）作为住院死亡率的预测指标，与 Charlson 合并症指数（CCI）和 Elixhauser 合并症指数（ECI）评分进行比较。我们进行了一项回顾性观察研究，使用 2011 年至 2016 年葡萄牙大陆公立医院的成年患者住院数据。计算了模型区分度（C 统计量/曲线下面积）和拟合优度（R 平方）。我们的研究结果包含了 4176142 例住院患者，其中 5.9%的患者在住院期间死亡。与 CCI 和 ECI 模型相比，考虑 SOI、年龄和性别因素的模型在 49.6%（266 个 APR-DRG 中的 132 个）的 APR-DRG 中具有统计学上显著更高的区分度，而在考虑 ROM 的模型中则为 33.5%的 APR-DRG 中具有统计学上显著更高的区分度。在这两个模型中，SOI 在近 20%的 APR-DRG 中表现最佳。一些特定的 APR-DRG 具有较好的区分度（例如与烧伤、病毒性脑膜炎或特定移植相关的 APR-DRG）。总之，SOI 或 ROM 与年龄和性别相结合，优于更广泛使用的合并症指数。尽管 ROM 是唯一专门用于预测住院死亡率的评分，但 SOI 的表现更好。这些发现有助于医院或组织模型的基准测试或流行病学分析。
