From The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Exp Clin Transplant. 2023 Aug;21(8):671-677. doi: 10.6002/ect.2023.0134.
In-hospital mortality after heart transplant is around 5%. Predicting the risk of in-hospital mortality can be informative for transplant candidacy and prognosis. The Elixhauser Comorbidity Index is an International Statistical Classification of Diseases and Related Health Problems diagnostic code-based comorbidity measurement tool that can predict inhospital mortality. This study aimed to develop a composite recipient comorbidity and demographic index based on the Elixhauser Comorbidity Index to predict the in-hospital mortality rate of heart transplant recipients.
This study assessed the inhospital mortality risk prediction with the Elixhauser Comorbidity Index and demographic variables of heart transplant recipients from the National Inpatient Sample database. A multivariable model that included demographic information and Elixhauser Comorbidity Index was used to assess in-hospital mortality, with Elixhauser Comorbidity Index and age used to develop a single-index adjusted Elixhauser Comorbidity Index.
Among 3469 heart transplant patients identified from 2015 (quarter 4) to 2020, in-hospital mortality was 5.13%. Age best predicted (C statistic 0.673; 95% CI, 0.638-0.709) in-hospital mortality, followed by the Elixhauser Comorbidity Index (C statistic 0.638; 95% CI, 0.598-0.678) and race and ethnicity (C statistic 0.571; 95% CI, 0.533-0.609). Sex did not have predictive power (C statistic 0.501; 95% CI, 0.467-0.535). In the multivariable model with demographics, the predictive power of the Elixhauser Comorbidity Index was improved (C statistic 0.753; 95% CI, 0.720-0.785; DeLong P < .001). The singleindex adjusted model had comparable discriminative power (C statistic 0.763; 95% CI, 0.731-0.794; DeLong P = .766) to the Elixhauser Comorbidity Index in predicting in-hospital mortality. Both models had good calibration with Brier score <0.05.
The Elixhauser Comorbidity Index is an effective measure to predict in-hospital mortality after heart transplant. The improved measure adjusted index could be used as a standardized composite score to account for recipient comorbidity and demographics across clinical studies.
心脏移植后的院内死亡率约为 5%。预测院内死亡率有助于评估移植候选者的风险和预后。Elixhauser 合并症指数是一种基于国际疾病分类和相关健康问题诊断代码的合并症测量工具，可预测院内死亡率。本研究旨在基于 Elixhauser 合并症指数开发一种综合受体合并症和人口统计学指数，以预测心脏移植受者的院内死亡率。
本研究使用国家住院患者样本数据库评估了 Elixhauser 合并症指数和心脏移植受者人口统计学变量对院内死亡率的预测。使用包含人口统计学信息和 Elixhauser 合并症指数的多变量模型评估院内死亡率，使用 Elixhauser 合并症指数和年龄开发单一指数调整的 Elixhauser 合并症指数。
在 2015 年（第 4 季度）至 2020 年期间从国家住院患者样本数据库中确定的 3469 例心脏移植患者中，院内死亡率为 5.13%。年龄是预测院内死亡率的最佳指标（C 统计量 0.673；95%置信区间，0.638-0.709），其次是 Elixhauser 合并症指数（C 统计量 0.638；95%置信区间，0.598-0.678）和种族（C 统计量 0.571；95%置信区间，0.533-0.609）。性别没有预测能力（C 统计量 0.501；95%置信区间，0.467-0.535）。在包含人口统计学信息的多变量模型中，Elixhauser 合并症指数的预测能力得到了提高（C 统计量 0.753；95%置信区间，0.720-0.785；DeLong P <.001）。单指数调整模型具有与 Elixhauser 合并症指数相当的判别能力（C 统计量 0.763；95%置信区间，0.731-0.794；DeLong P =.766），可用于预测心脏移植后的院内死亡率。两种模型的校准效果都很好，Brier 评分均<0.05。
Elixhauser 合并症指数是预测心脏移植后院内死亡率的有效指标。改进后的调整指数可作为一种标准化综合评分，用于评估临床研究中受体的合并症和人口统计学特征。
