Predictive Accuracy of 29-Comorbidity Index for In-Hospital Deaths in US Adult Hospitalizations with a Diagnosis of Venous Thromboembolism

James Tsai,Althea M Grant,W Craig Hooper,Karon Abe,Michele G Beckman,Sheree L Boulet,Arul Earnest

doi:10.1371/journal.pone.0070061

Abstract

BackgroundVenous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a significant source of mortality and morbidity worldwide. By analyzing data of the 2010 Nationwide Inpatient Sample from the Agency for Healthcare Research and Quality (AHRQ), we evaluated the predictive accuracy of the AHRQ’s 29-comorbidity index with in-hospital death among US adult hospitalizations with a diagnosis of VTE.MethodsWe assessed the case-fatality and prevalence of comorbidities among a sample of 153,518 adult hospitalizations with a diagnosis of VTE that comprised 87,605 DVTs and 65,913 PEs (with and without DVT). We estimated adjusted odds ratios and 95% confidence intervals with multivariable logistic regression models by using comorbidities as predictors and status of in-hospital death as an outcome variable. We assessed the c-statistics for the predictive accuracy of the logistic regression models.ResultsIn 2010, approximately 41,944 in-hospital deaths (20,212 with DVT and 21,732 with PE) occurred among 770,137 hospitalizations with a diagnosis of VTE. When compared separately to hospitalizations with VTE, DVT, or PE that had no corresponding comorbidities, congestive heart failure, chronic pulmonary disease, coagulopathy, liver disease, lymphoma, fluid and electrolyte disorders, metastatic cancer, other neurological disorders, peripheral vascular disorders, pulmonary circulation disorders, renal failure, solid tumor without metastasis, and weight loss were positively and independently associated with 10%−125% increased likelihoods of in-hospital death. The c-statistic values ranged from 0.776 to 0.802.ConclusionThe results of this study indicated that comorbidity was associated independently with risk of death among hospitalizations with VTE and among hospitalizations with DVT or PE. The AHRQ 29-comorbidity index provides acceptable to excellent predictive accuracy for in-hospital deaths among adult hospitalizations with VTE and among those with DVT or PE.

Highlights

Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a significant source of mortality, morbidity, and impaired health-related quality of life worldwide [1,2,3,4]
We found that a total of 41,944 in-hospital deaths occurred among 770,137 hospitalizations with a diagnosis of VTE in 2010, comprising 20,212 deaths among 440,151 hospitalizations with DVT and 21,732 deaths among 329,986 hospitalizations with PE
High case-fatality rates were observed among subgroups in which patients were 80 years of age or older, were male, were other race or ethnicity, had a hospital stay of at least 7 days, had Medicare as primary expected payer, had a ‘‘non-operating room procedure’’ and had at least five comorbidities (Table 1)

Summary

Introduction

Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a significant source of mortality, morbidity, and impaired health-related quality of life worldwide [1,2,3,4]. The 2008 Surgeon General’s Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism suggested that VTE might be responsible for approximately 100,0002180,000 deaths per year in the United States [5]. Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a significant source of mortality and morbidity worldwide. By analyzing data of the 2010 Nationwide Inpatient Sample from the Agency for Healthcare Research and Quality (AHRQ), we evaluated the predictive accuracy of the AHRQ’s 29comorbidity index with in-hospital death among US adult hospitalizations with a diagnosis of VTE

Methods

Results

Conclusion