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A new comorbidities index for risk stratification for treatment of unruptured cerebral aneurysms
- Source :
- Journal of neurosurgery. 125(3)
- Publication Year :
- 2016
-
Abstract
- OBJECTIVE Comorbidities have an impact on risk stratification for outcomes in analyses of large patient databases. Although the Charlson Comorbidity Index (CCI) and the Elixhauser Comorbidity Index (ECI) are the most commonly used comorbidity indexes, these have not been validated for patients with unruptured cerebral aneurysms; therefore, the authors created a comorbidity index specific to these patients. METHODS The authors extracted all records involving unruptured cerebral aneurysms treated with clipping, coiling, or both from the Nationwide Inpatient Sample (2002–2010). They assessed the effect of 37 variables on poor outcome and used the results to create a risk score for these patients. The authors used a validation data set and bootstrapping to evaluate the new index and compared it to CCI and ECI in prediction of poor outcome, mortality, length of stay, and hospital charges. RESULTS The index assigns integer values (−2 to 7) to 20 comorbidities: neurological disorder, renal insufficiency, gastrointestinal bleeding, paralysis, acute myocardial infarction, electrolyte disorder, weight loss, metastatic cancer, drug abuse, arrhythmia, coagulopathy, cerebrovascular accident, psychosis, alcoholism, perivascular disease, valvular disease, tobacco use, hypothyroidism, depression, and hypercholesterolemia. Values are summed to determine a patient's risk score. The new index was better at predicting poor outcome than CCI or ECI (area under the receiver operating characteristic curve [AUC] 0.814 [95% CI 0.798–0.830], vs 0.694 and 0.712, respectively, for the other indices), and it was also better at predicting mortality (AUC 0.775 [95% CI 0.754–0.792], vs 0.635 and 0.657, respectively, for CCI and ECI). CONCLUSIONS This new comorbidity index outperforms the CCI and ECI in predicting poor outcome, mortality, length of stay, and total charges for patients with unruptured cerebral aneurysm. Reevaluation of other patient cohorts is warranted to determine the impact of more accurate patient stratification.
- Subjects :
- Male
Gastrointestinal bleeding
medicine.medical_specialty
Neurological disorder
Comorbidity
030204 cardiovascular system & hematology
Risk Assessment
03 medical and health sciences
0302 clinical medicine
Internal medicine
medicine
Humans
Myocardial infarction
Depression (differential diagnoses)
Framingham Risk Score
Receiver operating characteristic
business.industry
Intracranial Aneurysm
General Medicine
Middle Aged
medicine.disease
Surgery
Female
Risk assessment
business
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 19330693
- Volume :
- 125
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- Journal of neurosurgery
- Accession number :
- edsair.doi.dedup.....3d4807400cab08ef30331fcc7c10f2d9