https://orcid.org/0000-0002-2699-191X
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Abstract
Purpose
Burden of comorbidities appears to be related to clinical outcomes in hospitalized patients. Clinical stratification of admitted patients could be obtained calculating a comorbidity score, which represents the simplest way to identify the severity of patients’ clinical conditions and a practical approach to assess prevalent comorbidities. Our aim was to validate a modified Elixhauser score for predicting in-hospital mortality (IHM) in internal medicine admissions and to compare it with a different one derived from clinical data previously used in a similar setting, having a good prognostic accuracy.
Patients and Methods
A single-center retrospective study enrolled all patients admitted to internal medicine department between January and June 2016. A modified Elixhauser score was calculated from chart review and administrative data; moreover, a second prognostic index was calculated from chart review only. Comorbidity scores were compared using c-statistic.
Results
We analyzed 1614 individuals without selecting the reason for admission, 224 (13.9%) died during hospital stay. Deceased subjects were older (83.3±9.1 vs 78.4±13.5 years; p<0.001) and had higher burden of comorbidities. The modified Elixhauser score calculated by administrative data and by chart review and the comparator one was 18.13±9.36 vs 24.43±11.27 vs 7.63±3.3, respectively, and the c-statistic was 0.758 (95% CI 0.727–0.790), 0.811 (95% CI 0.782–0.840) and 0.740 (95% CI 0.709–0.771), respectively.
Conclusion
The new modified Elixhauser score showed a similar performance to a previous clinical prognostic index when it was calculated using administrative data; however, its performance improved if calculation was based on chart review.
Acknowledgments
We are indebted to Mr Mauro Pasin from Hypertension Centre, University Hospital St. Anna, Ferrara, Italy for his valuable and precious collaboration. This work has been supported, in part, by a research grant from the Ministry of Education, University and Research (MIUR), [FFABR 2017 (Fondo Finanziamento Attività di Base della Ricerca) - Prof Fabio Fabbian 2017].
Disclosure
The authors declare that there are not any potential conflicts of interests that are directly or indirectly related to the data presented in the paper.