Li Renxi
medRxiv. 2023 Apr 10:2023.04.08.23288311. doi: 10.1101/2023.04.08.23288311.
For myocardial revascularization, coronary artery bypass grafting (CAGB) and percutaneous coronary intervention (PCI) are two common modalities but with high in-hospital mortality. A comorbidity index is useful to predict mortality or can be used with other covariates to develop point-scoring systems. This study aimed to develop specific comorbidity indices for patients who underwent coronary artery revascularization.
Patients who underwent CABG or PCI were identified in the National Inpatient Sample database between Q4 2015-2020. Patients of age<40 were excluded for congenital heart defects. Patients were randomly sampled into experimental (70%) and validation (30%) groups. Thirty-eight Elixhauser comorbidities were identified and included in multivariable regression to predict in-hospital mortality. Weight for each comorbidity was assigned and single indices, Li CABG Mortality Index (LCMI) and Li PCI Mortality Index (LPMI), were developed.
Mortality prediction by LCMI approached adequacy ( -statistic=0.691, 95% CI=0.682-0.701) and was comparable to multivariable regression with comorbidities ( -statistic=0.685, 95% CI=0.675-0.694). LCMI prediction performed significantly better than Elixhauser Comorbidity Index (ECI) ( -statistic=0.621, 95% CI=0.611-0.631) and can be further improved by adjusting age ( -statistic=0.721, 95% CI=0.712-0.730). LPMI moderately predicted in-hospital mortality ( -statistic=0.666, 95% CI=0.660-0.672) and performed significantly better than ECI ( -statistic=0.610, 95% CI=0.604-0.616). LPMI performed better than the all-comorbidity multivariable regression ( -statistic=0.658, 95% CI=0.652-0.663). After age adjustment, LPMI prediction was significantly increased and was approaching adequacy ( -statistic=0.695, 95% CI=0.690-0.701).
LCMI and LPMI effectively predicted in-hospital mortality. These indices were validated and performed superior to ECI. The adjustment of age increased their predictive power to adequacy, implicating potential clinical application.
对于心肌血运重建，冠状动脉旁路移植术（CABG）和经皮冠状动脉介入治疗（PCI）是两种常见的方式，但院内死亡率较高。合并症指数有助于预测死亡率，或可与其他协变量一起用于开发评分系统。本研究旨在为接受冠状动脉血运重建的患者开发特定的合并症指数。
在2015年第4季度至2020年的国家住院样本数据库中识别接受CABG或PCI的患者。年龄<40岁的患者因先天性心脏缺陷被排除。患者被随机抽样分为试验组（70%）和验证组（30%）。识别出38种埃利克斯豪泽合并症并纳入多变量回归以预测院内死亡率。为每种合并症分配权重，并开发了单一指数，即李CABG死亡率指数（LCMI）和李PCI死亡率指数（LPMI）。
LCMI对死亡率的预测接近充分（卡方统计量=0.691，95%置信区间=0.682-0.701），与合并症的多变量回归相当（卡方统计量=0.685，95%置信区间=0.675-0.694）。LCMI预测的表现明显优于埃利克斯豪泽合并症指数（ECI）（卡方统计量=0.621，95%置信区间=0.611-0.631），并且通过调整年龄可以进一步改善（卡方统计量=0.721，95%置信区间=0.712-0.730）。LPMI对院内死亡率的预测中等（卡方统计量=0.666，95%置信区间=0.660-0.672），并且表现明显优于ECI（卡方统计量=0.610，95%置信区间=0.604-0.616）。LPMI的表现优于所有合并症的多变量回归（卡方统计量=0.658，95%置信区间=0.652-0.663）。经过年龄调整后，LPMI的预测显著提高并接近充分（卡方统计量=0.695，95%置信区间=0.690-0.701）。
LCMI和LPMI有效地预测了院内死亡率。这些指数经过验证，表现优于ECI。年龄调整提高了它们的预测能力至充分水平，暗示了潜在的临床应用价值。
