A disease-specific comorbidity index for predicting mortality in patients admitted to hospital with a cardiac condition

Lorenzo Azzalini, Malorie Chabot-Blanchet, Danielle A. Southern, Anna Nozza, Stephen B. Wilton, Michelle M. Graham, Guillaume Marquis Gravel, Jean Pierre Bluteau, Jean Lucien Rouleau, Marie Claude Guertin, E. Marc Jolicoeur

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Comorbidity indexes derived from administrative databases are essential tools of research in global health. We sought to develop and validate a novel cardiac-specific comorbidity index, and to compare its accuracy with the generic Charlson–Deyo and Elixhauser comorbidity indexes. METHODS: We derived the cardiac-specific comorbidity index from consecutive patients who were admitted to hospital at a tertiary-care cardiology hospital in Quebec. We used logistic regression analysis and incorporated age, sex and 22 clinically relevant comorbidities to build the index. We compared the cardiac-specific comorbidity index with refitted Charlson–Deyo and Elixhauser comorbidity indexes using the C-statistic and net reclassification improvement to predict in-hospital death, and the Akaike information criterion to predict length of stay. We validated our findings externally in an independent cohort obtained from a provincial registry of coronary disease in Alberta. RESULTS: The novel cardiac-specific comorbidity index outperformed the refitted generic Charlson–Deyo and Elixhauser comorbidity indexes for predicting in-hospital mortality in the derivation population (n = 10 137): C-statistic 0.95 (95% confidence interval [CI] 0.94–0.9) v. 0.81 (95% CI 0.77–0.84) and 0.86 (95% CI 0.82–0.89), respectively. In the validation population (n = 17 877), the cardiac-specific comorbidity index was similarly better: C-statistic 0.92 (95% CI 0.89–0.94) v. 0.76 (95% CI 0.71–0.81) and 0.82 (95% CI 0.78–0.86), respectively, and also numerically outperformed the Charlson–Deyo and Elixhauser comorbidity indexes for predicting 1-year mortality (C-statistic 0.78 [95% CI 0.76–0.80] v. 0.75 [95% CI 0.73–0.77] and 0.77 [95% CI 0.75–0.79], respectively). Similarly, the cardiac-specific comorbidity index showed better fit for the prediction of length of stay. The net reclassification improvement using the cardiac-specific comorbidity index for the prediction of death was 0.290 compared with the Charlson–Deyo comorbidity index and 0.192 compared with the Elixhauser comorbidity index. INTERPRETATION: The cardiac-specific comorbidity index predicted in-hospital and 1-year death and length of stay in cardiovascular populations better than existing generic models. This novel index may be useful for research of cardiology outcomes performed with large administrative databases.

Original languageEnglish
Pages (from-to)E299-E307
JournalCMAJ
Volume191
Issue number11
DOIs
Publication statusPublished - Mar 18 2019

ASJC Scopus subject areas

  • Medicine(all)

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