Ahmad A Elshafei, Guy Nehrenz, Patrick C Hardigan, Ellen A Becker
{"title":"使用 CORE 和 CORE+ 评分预测慢性阻塞性肺病患者的再入院情况。","authors":"Ahmad A Elshafei, Guy Nehrenz, Patrick C Hardigan, Ellen A Becker","doi":"10.4187/respcare.11766","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Identifying persons with COPD at high risk for hospital readmission provides opportunities for efficient and appropriate care to lower readmission risk. This study examined 30-d and 60-d hospital readmission prediction of the COPD-readmission (CORE) score and a newly developed CORE+ score. The relationship between CORE and CORE+ scores and ICU admission, endotracheal intubation, and in-hospital noninvasive ventilation (NIV) use was explored.</p><p><strong>Methods: </strong>A retrospective cohort study evaluated participants with spirometry-confirmed COPD from 2 Midwestern academic hospitals. The CORE score variables included eosinophil blood count, FEV<sub>1</sub>/FVC (<0.70) and FEV<sub>1</sub> (≤40% of predicted), triple inhaler therapy, previous hospitalization, and presence of neuromuscular disease. Out-of-hospital NIV use and Charlson comorbidity index were added to compose the CORE+ score. Researchers assessed associations between variables and outcomes with chi-square test or Fisher exact test, compared results of CORE and CORE+ scores with Wilcoxon signed-rank test, assessed each score's 30-d and 60-d readmission predictive power with multiple logistic regression, and evaluated predictive accuracy with AUC of receiver operating characteristic using alpha < 0.05.</p><p><strong>Results: </strong>Of 391 participants, the study found a 22% 30-d, all-cause readmission rate and a 16% 60-d, all-cause readmission rate. CORE+ score had better predictive accuracy than the CORE score for 30-d readmission (area under the curve 0.81 [95% CI 0.76-0.86]; AUC 0.73 [95% CI 0.66-0.79], <i>P</i> < .001) and 60-d readmission (AUC 0.77 [95% CI 0.71-0.83]; AUC 0.75 [95% CI 0.69-0.81], <i>P</i> < .001). Participants who used in-hospital NIV had higher median CORE+ scores (<i>P</i> = < .001).</p><p><strong>Conclusions: </strong>CORE and CORE+ scores demonstrated good to very good predictive accuracy for 30-d and 60-d readmission, respectively. Moreover, this study demonstrated a linear relationship between in-hospital NIV use and CORE+ score.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4000,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prediction of Hospital Readmission Using the CORE and CORE+ Scores in Persons With COPD.\",\"authors\":\"Ahmad A Elshafei, Guy Nehrenz, Patrick C Hardigan, Ellen A Becker\",\"doi\":\"10.4187/respcare.11766\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Identifying persons with COPD at high risk for hospital readmission provides opportunities for efficient and appropriate care to lower readmission risk. This study examined 30-d and 60-d hospital readmission prediction of the COPD-readmission (CORE) score and a newly developed CORE+ score. The relationship between CORE and CORE+ scores and ICU admission, endotracheal intubation, and in-hospital noninvasive ventilation (NIV) use was explored.</p><p><strong>Methods: </strong>A retrospective cohort study evaluated participants with spirometry-confirmed COPD from 2 Midwestern academic hospitals. The CORE score variables included eosinophil blood count, FEV<sub>1</sub>/FVC (<0.70) and FEV<sub>1</sub> (≤40% of predicted), triple inhaler therapy, previous hospitalization, and presence of neuromuscular disease. Out-of-hospital NIV use and Charlson comorbidity index were added to compose the CORE+ score. Researchers assessed associations between variables and outcomes with chi-square test or Fisher exact test, compared results of CORE and CORE+ scores with Wilcoxon signed-rank test, assessed each score's 30-d and 60-d readmission predictive power with multiple logistic regression, and evaluated predictive accuracy with AUC of receiver operating characteristic using alpha < 0.05.</p><p><strong>Results: </strong>Of 391 participants, the study found a 22% 30-d, all-cause readmission rate and a 16% 60-d, all-cause readmission rate. CORE+ score had better predictive accuracy than the CORE score for 30-d readmission (area under the curve 0.81 [95% CI 0.76-0.86]; AUC 0.73 [95% CI 0.66-0.79], <i>P</i> < .001) and 60-d readmission (AUC 0.77 [95% CI 0.71-0.83]; AUC 0.75 [95% CI 0.69-0.81], <i>P</i> < .001). Participants who used in-hospital NIV had higher median CORE+ scores (<i>P</i> = < .001).</p><p><strong>Conclusions: </strong>CORE and CORE+ scores demonstrated good to very good predictive accuracy for 30-d and 60-d readmission, respectively. Moreover, this study demonstrated a linear relationship between in-hospital NIV use and CORE+ score.</p>\",\"PeriodicalId\":21125,\"journal\":{\"name\":\"Respiratory care\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2024-10-29\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Respiratory care\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.4187/respcare.11766\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Respiratory care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.4187/respcare.11766","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
Prediction of Hospital Readmission Using the CORE and CORE+ Scores in Persons With COPD.
Background: Identifying persons with COPD at high risk for hospital readmission provides opportunities for efficient and appropriate care to lower readmission risk. This study examined 30-d and 60-d hospital readmission prediction of the COPD-readmission (CORE) score and a newly developed CORE+ score. The relationship between CORE and CORE+ scores and ICU admission, endotracheal intubation, and in-hospital noninvasive ventilation (NIV) use was explored.
Methods: A retrospective cohort study evaluated participants with spirometry-confirmed COPD from 2 Midwestern academic hospitals. The CORE score variables included eosinophil blood count, FEV1/FVC (<0.70) and FEV1 (≤40% of predicted), triple inhaler therapy, previous hospitalization, and presence of neuromuscular disease. Out-of-hospital NIV use and Charlson comorbidity index were added to compose the CORE+ score. Researchers assessed associations between variables and outcomes with chi-square test or Fisher exact test, compared results of CORE and CORE+ scores with Wilcoxon signed-rank test, assessed each score's 30-d and 60-d readmission predictive power with multiple logistic regression, and evaluated predictive accuracy with AUC of receiver operating characteristic using alpha < 0.05.
Results: Of 391 participants, the study found a 22% 30-d, all-cause readmission rate and a 16% 60-d, all-cause readmission rate. CORE+ score had better predictive accuracy than the CORE score for 30-d readmission (area under the curve 0.81 [95% CI 0.76-0.86]; AUC 0.73 [95% CI 0.66-0.79], P < .001) and 60-d readmission (AUC 0.77 [95% CI 0.71-0.83]; AUC 0.75 [95% CI 0.69-0.81], P < .001). Participants who used in-hospital NIV had higher median CORE+ scores (P = < .001).
Conclusions: CORE and CORE+ scores demonstrated good to very good predictive accuracy for 30-d and 60-d readmission, respectively. Moreover, this study demonstrated a linear relationship between in-hospital NIV use and CORE+ score.
期刊介绍：
RESPIRATORY CARE is the official monthly science journal of the American Association for Respiratory Care. It is indexed in PubMed and included in ISI''s Web of Science.
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