Assessment and Improvement of Elixhauser Comorbidity Index for Predicting In-hospital Mortality in Heart Transplant Patients

Abstract

Background: Heart transplant (HT) has a high in-hospital mortality of around 5%. Risk prediction in-hospital mortality can be informative for transplant candidacy and post-HT prognosis. Elixhauser Comorbidity Index (ECI) is an ICD diagnostic code-based comorbidity measurement tool that can predict in-hospital mortality. While it has been validated in the large in-patient population, the accuracy of the mortality prediction has not been assessed in HT. Methods: This study assessed the in-hospital mortality risk prediction by ECI as well as demographic variables in HT patients in the National Inpatient Sample (NIS) database. Demographic information was included in the multivariable ECI with demographics (ECID) model to assess in-hospital mortality. Moreover, ECI and age were used to develop a single index adjusted ECI (aECI) for mortality prediction. Results: Age best predicts (c-statistic = 0.673, 95% CI = 0.638-0.709) in-hospital mortality, followed by ECI (c-statistic = 0.638, 95% CI = 0.598-0.678), race (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) for in-hospital mortality. The predictive power of ECI was improved (c-statistic = 0.753, 95% CI = 0.720-0.785) in the ECID model. The single measure aECI had comparable discriminative power (c-statistic = 0.763, 95% CI = 0.731-0.794) to ECID in predicting in-hospital mortality. Conclusion: This study showed that ECI was an effective measure to predict post-HT in-hospital mortality. The improved measure aECI can be easily derived from ECI as a quick reference to assess post-HT in-hospital mortality in both the clinic and health administration.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study did not receive any funding

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study used only openly available human data from The National (Nationwide) Inpatient Sample (NIS) that were originally located at https://hcup-us.ahrq.gov/databases.jsp

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

All data produced in the present study are available upon reasonable request to the authors

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