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Derivation of age-adjusted LACE index thresholds in the prediction of mortality and frequent hospital readmissions in adults

The LACE index has been shown to predict hospital readmissions and death with variable accuracy. A LACE index ≥ 10 is considered as high risk in the existing literature. We aimed to derive age-specific LACE index thresholds in the prediction of mortality and frequent readmissions. Analysis of prospe...

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Autores principales: Fry, Christopher Henry, Heppleston, Erica, Fluck, David, Han, Thang Sieu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7511461/
https://www.ncbi.nlm.nih.gov/pubmed/32725518
http://dx.doi.org/10.1007/s11739-020-02448-3
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author Fry, Christopher Henry
Heppleston, Erica
Fluck, David
Han, Thang Sieu
author_facet Fry, Christopher Henry
Heppleston, Erica
Fluck, David
Han, Thang Sieu
author_sort Fry, Christopher Henry
collection PubMed
description The LACE index has been shown to predict hospital readmissions and death with variable accuracy. A LACE index ≥ 10 is considered as high risk in the existing literature. We aimed to derive age-specific LACE index thresholds in the prediction of mortality and frequent readmissions. Analysis of prospectively collected data of consecutive alive-discharge episodes between 01/04/2017 and 31/03/2019 to a single hospital was conducted. The derivation of LACE index thresholds for predicting all-cause mortality within 6 months of hospital discharge or frequent readmissions (≥ 2 times within 28 days) was examined by receiver operating characteristics (ROC) in 32270 patients (14878 men, 17392 women) aged 18–107 year (mean = 64.0 years, SD = 20.5). For all patients with a LACE index ≥ 10, the area under the curve (AUC) for predicting mortality was 80.5% (95% CI 79.7–81.3) and for frequent readmissions was 84.0% (83.0–85.1). Two-graph ROC plots showed that the LACE index threshold where sensitivity equates specificity was 9.5 (95% intermediate range = 5.6–13.5) for predicting mortality and 10.3 (95% intermediate range = 6.6–13.6) for frequent readmissions. These thresholds were lowest among youngest individuals and rose progressively with age for mortality prediction: 18–49 years = 5.0, 50–59 years = 6.5, 60–69 years = 8.0, 70–79 years = 9.8 and ≥ 80 years = 11.6, and similarly for frequent readmissions: 18–49 years = 5.1, 50–59 years = 7.5, 60–69 years = 9.1, 70–79 years = 10.6 and ≥ 80 years = 12.0. Positive and negative likelihood ratios (LRs) ranged 1.5–3.3 and 0.4-0.6 for predicting mortality, and 2.5–4.4 and 0.3–0.6 for frequent readmissions, respectively, with stronger evidence in younger than in older individuals (LRs further from unity). In conclusion, the LACE index predicts mortality and frequent readmissions at lower thresholds and stronger in younger than in older individuals. Age should be taken into account when using the LACE index for identifying patients at high risk. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11739-020-02448-3) contains supplementary material, which is available to authorized users.
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spelling pubmed-75114612020-10-05 Derivation of age-adjusted LACE index thresholds in the prediction of mortality and frequent hospital readmissions in adults Fry, Christopher Henry Heppleston, Erica Fluck, David Han, Thang Sieu Intern Emerg Med Ce - Original The LACE index has been shown to predict hospital readmissions and death with variable accuracy. A LACE index ≥ 10 is considered as high risk in the existing literature. We aimed to derive age-specific LACE index thresholds in the prediction of mortality and frequent readmissions. Analysis of prospectively collected data of consecutive alive-discharge episodes between 01/04/2017 and 31/03/2019 to a single hospital was conducted. The derivation of LACE index thresholds for predicting all-cause mortality within 6 months of hospital discharge or frequent readmissions (≥ 2 times within 28 days) was examined by receiver operating characteristics (ROC) in 32270 patients (14878 men, 17392 women) aged 18–107 year (mean = 64.0 years, SD = 20.5). For all patients with a LACE index ≥ 10, the area under the curve (AUC) for predicting mortality was 80.5% (95% CI 79.7–81.3) and for frequent readmissions was 84.0% (83.0–85.1). Two-graph ROC plots showed that the LACE index threshold where sensitivity equates specificity was 9.5 (95% intermediate range = 5.6–13.5) for predicting mortality and 10.3 (95% intermediate range = 6.6–13.6) for frequent readmissions. These thresholds were lowest among youngest individuals and rose progressively with age for mortality prediction: 18–49 years = 5.0, 50–59 years = 6.5, 60–69 years = 8.0, 70–79 years = 9.8 and ≥ 80 years = 11.6, and similarly for frequent readmissions: 18–49 years = 5.1, 50–59 years = 7.5, 60–69 years = 9.1, 70–79 years = 10.6 and ≥ 80 years = 12.0. Positive and negative likelihood ratios (LRs) ranged 1.5–3.3 and 0.4-0.6 for predicting mortality, and 2.5–4.4 and 0.3–0.6 for frequent readmissions, respectively, with stronger evidence in younger than in older individuals (LRs further from unity). In conclusion, the LACE index predicts mortality and frequent readmissions at lower thresholds and stronger in younger than in older individuals. Age should be taken into account when using the LACE index for identifying patients at high risk. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11739-020-02448-3) contains supplementary material, which is available to authorized users. Springer International Publishing 2020-07-28 2020 /pmc/articles/PMC7511461/ /pubmed/32725518 http://dx.doi.org/10.1007/s11739-020-02448-3 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Ce - Original
Fry, Christopher Henry
Heppleston, Erica
Fluck, David
Han, Thang Sieu
Derivation of age-adjusted LACE index thresholds in the prediction of mortality and frequent hospital readmissions in adults
title Derivation of age-adjusted LACE index thresholds in the prediction of mortality and frequent hospital readmissions in adults
title_full Derivation of age-adjusted LACE index thresholds in the prediction of mortality and frequent hospital readmissions in adults
title_fullStr Derivation of age-adjusted LACE index thresholds in the prediction of mortality and frequent hospital readmissions in adults
title_full_unstemmed Derivation of age-adjusted LACE index thresholds in the prediction of mortality and frequent hospital readmissions in adults
title_short Derivation of age-adjusted LACE index thresholds in the prediction of mortality and frequent hospital readmissions in adults
title_sort derivation of age-adjusted lace index thresholds in the prediction of mortality and frequent hospital readmissions in adults
topic Ce - Original
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7511461/
https://www.ncbi.nlm.nih.gov/pubmed/32725518
http://dx.doi.org/10.1007/s11739-020-02448-3
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