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Utility of Biomarkers to Improve Prediction of Readmission or Mortality After Cardiac Surgery.
- Source :
-
The Annals of thoracic surgery [Ann Thorac Surg] 2018 Nov; Vol. 106 (5), pp. 1294-1301. Date of Electronic Publication: 2018 Aug 04. - Publication Year :
- 2018
-
Abstract
- Background: Hospital readmission within 30 days is associated with higher risks of complications, death, and increased costs. Accurate statistical models to stratify the risk of 30-day readmission or death after cardiac surgery could help clinical teams focus care on those patients at highest risk. We hypothesized biomarkers could improve prediction for readmission or mortality.<br />Methods: Levels of ST2, galectin-3, N-terminal pro-brain natriuretic peptide, cystatin C, interleukin-6, and interleukin-10 were measured in samples from 1,046 patients discharged after isolated coronary artery bypass graft surgery from eight medical centers, with external validation in 1,194 patients from five medical centers. Thirty-day readmission or mortality were ascertained using Medicare, state all-payer claims, and the National Death Index. We tested and externally validated the clinical models and the biomarker panels using area under the receiver-operating characteristics (AUROC) statistics.<br />Results: There were 112 patients (10.7%) who were readmitted or died within 30 days after coronary artery bypass graft surgery. The Society of Thoracic Surgeons augmented clinical model resulted in an AUROC of 0.66 (95% confidence interval: 0.61 to 0.71). The biomarker panel with The Society of Thoracic Surgeons augmented clinical model resulted in an AUROC of 0.74 (bootstrapped 95% confidence interval: 0.69 to 0.79, p < 0.0001). External validation of the model showed limited improvement with the addition of a biomarker panel, with an AUROC of 0.51 (95% confidence interval: 0.45 to 0.56).<br />Conclusions: Although biomarkers significantly improved prediction of 30-day readmission or mortality in our derivation cohort, the external validation of the biomarker panel was poor. Biomarkers perform poorly, much like other efforts to improve prediction of readmission, suggesting there are many other factors yet to be explored to improve prediction of readmission.<br /> (Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Biomarkers blood
Cardiac Surgical Procedures adverse effects
Cardiac Surgical Procedures methods
Cardiac Surgical Procedures mortality
Cohort Studies
Coronary Artery Bypass adverse effects
Coronary Artery Bypass methods
Databases, Factual
Female
Humans
Logistic Models
Male
Middle Aged
Postoperative Complications mortality
Postoperative Complications physiopathology
Postoperative Complications therapy
Predictive Value of Tests
ROC Curve
Retrospective Studies
Risk Assessment
Survival Analysis
United States
Cause of Death
Coronary Artery Bypass mortality
Cystatin C blood
Hospital Mortality
Natriuretic Peptide, Brain blood
Patient Readmission statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1552-6259
- Volume :
- 106
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- The Annals of thoracic surgery
- Publication Type :
- Academic Journal
- Accession number :
- 30086283
- Full Text :
- https://doi.org/10.1016/j.athoracsur.2018.06.052