RENXİ Lİ
Experimental and Clinical Transplantation - 2023;21(8):671-677
Objectives: In-hospital mortality after heart transplant is around 5%. Predicting the risk of in-hospital mortality can be informative for transplant candidacy and prognosis. The Elixhauser Comorbidity Index is an International Statistical Classification of Diseases and Related Health Problems diagnostic code-based comorbidity measurement tool that can predict inhospital mortality. This study aimed to develop a composite recipient comorbidity and demographic index based on the Elixhauser Comorbidity Index to predict the in-hospital mortality rate of heart transplant recipients. Materials and Methods: This study assessed the inhospital mortality risk prediction with the Elixhauser Comorbidity Index and demographic variables of heart transplant recipients from the National Inpatient Sample database. A multivariable model that included demographic information and Elixhauser Comorbidity Index was used to assess in-hospital mortality, with Elixhauser Comorbidity Index and age used to develop a single-index adjusted Elixhauser Comorbidity Index. Results: Among 3469 heart transplant patients identified from 2015 (quarter 4) to 2020, in-hospital mortality was 5.13%. Age best predicted (C statistic 0.673; 95% CI, 0.638-0.709) in-hospital mortality, followed by the Elixhauser Comorbidity Index (C statistic 0.638; 95% CI, 0.598-0.678) and race and ethnicity (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). In the multivariable model with demographics, the predictive power of the Elixhauser Comorbidity Index was improved (C statistic 0.753; 95% CI, 0.720-0.785; DeLong P < .001). The singleindex adjusted model had comparable discriminative power (C statistic 0.763; 95% CI, 0.731-0.794; DeLong P = .766) to the Elixhauser Comorbidity Index in predicting in-hospital mortality. Both models had good calibration with Brier score <0.05. Conclusions: The Elixhauser Comorbidity Index is an effective measure to predict in-hospital mortality after heart transplant. The improved measure adjusted index could be used as a standardized composite score to account for recipient comorbidity and demographics across clinical studies.
