Lin Shih-Jiun, Liu Cheng-Chi, Tsai David Ming Then, Shih Ya-Hsueh, Lin Chun-Liang, Hsu Yung-Chien
Department of Nephrology, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi 613016, Taiwan.
Kidney and Diabetic Complications Research Team (KDCRT), Chang Gung Memorial Hospital, Chiayi 613016, Taiwan.
Diagnostics (Basel). 2024 Mar 14;14(6):620. doi: 10.3390/diagnostics14060620.
Hospital revisits significantly contribute to financial burden. Therefore, developing strategies to reduce hospital revisits is crucial for alleviating the economic impacts. However, this critical issue among peritoneal dialysis (PD) patients has not been explored in previous research. This single-center retrospective study, conducted at Chang Gung Memorial Hospital, Chiayi branch, included 1373 PD patients who visited the emergency room (ER) between Jan 2002 and May 2018. The objective was to predict hospital revisits, categorized into 72-h ER revisits and 14-day readmissions. Of the 1373 patients, 880 patients visiting the ER without subsequent hospital admission were analyzed to predict 72-h ER revisits. The remaining 493 patients, who were admitted to the hospital, were studied to predict 14-day readmissions. Logistic regression and decision tree methods were employed as prediction models. For the 72-h ER revisit study, 880 PD patients had a revisit rate of 14%. Both logistic regression and decision tree models demonstrated a similar performance. Furthermore, the logistic regression model identified coronary heart disease as an important predictor. For 14-day readmissions, 493 PD patients had a readmission rate of 6.1%. The decision tree model outperformed the logistic model with an area under the curve value of 79.4%. Additionally, a high-risk group was identified with a 36.4% readmission rate, comprising individuals aged 41 to 47 years old with a low alanine transaminase level ≤15 units per liter. In conclusion, we present a study using regression and decision tree models to predict hospital revisits in PD patients, aiding physicians in clinical judgment and improving care.
再次入院对经济负担有显著影响。因此，制定减少再次入院的策略对于减轻经济影响至关重要。然而，此前的研究尚未探讨腹膜透析（PD）患者中的这一关键问题。这项在嘉义长庚纪念医院进行的单中心回顾性研究纳入了2002年1月至2018年5月期间到急诊室就诊的1373例PD患者。目的是预测再次入院情况，分为72小时内急诊再次就诊和14天内再入院。在这1373例患者中，分析了880例到急诊室就诊后未随后住院的患者，以预测72小时内急诊再次就诊情况。对其余493例住院患者进行研究，以预测14天内再入院情况。采用逻辑回归和决策树方法作为预测模型。对于72小时内急诊再次就诊研究，880例PD患者的再次就诊率为14%。逻辑回归和决策树模型均表现出相似的性能。此外，逻辑回归模型确定冠心病是一个重要的预测因素。对于14天内再入院情况，493例PD患者的再入院率为6.1%。决策树模型的曲线下面积值为79.4%，优于逻辑模型。此外，还确定了一个高风险组，再入院率为36.4%，包括年龄在41至47岁、丙氨酸转氨酶水平低≤15单位/升的个体。总之，我们提出了一项使用回归和决策树模型预测PD患者再次入院情况的研究，有助于医生进行临床判断并改善护理。
