Faculty Collaboration Database

A novel risk score to stratify severity of Crohn's disease hospitalizations. Am J Gastroenterol 2010 Aug;105(8):1799-807

Date

03/11/2010

Pubmed ID

20216534

DOI

10.1038/ajg.2010.105

Scopus ID

2-s2.0-77955422317 (requires institutional sign-in at Scopus site)   57 Citations

Abstract

OBJECTIVES: Crohn's disease (CD) is a lifelong relapsing-remitting disease often requiring health-care contact, hospitalization, or surgery. General comorbidity indices were developed to predict mortality, which is rare in this population. There are limited tools to stratify these hospitalizations by severity.

METHODS: We used data obtained from the Nationwide Inpatient Sample 2004 to identify all CD-related hospitalizations using discharge diagnosis codes (International Classification of Diseases, 9th edition, Clinical Modification, ICD-9-CM, 555.x). Independent predictors on multivariate regression were identified and used to construct a quantitative risk score to predict severe hospitalizations (defined as requiring nonelective bowel surgery or hospitalization longer than 7 days). The performance of our risk score was compared with the Elixhauser and Charlson comorbidity indices, and validated in an independent sample of CD hospitalizations from 2007.

RESULTS: Our final study cohort consisted of 25,938 discharges, among which 6,169 were determined to be severe hospitalizations (23.8%). Independent predictors of disease severity included disease phenotype, anemia, malnutrition, and requirement for blood transfusion or total parenteral nutrition, as well as Clostridium difficile infection, admission to a teaching hospital, or inter-hospital transfer. The cumulative risk score ranged from 0 to 13 points, with scores >or=5 being considered to be of greater severity. A total of 15,330 (59.1%), 9,060 (34.9%), and 1,548 (6.0%) discharges were classified as being of low, intermediate, and high risk, respectively. An intermediate (odds ratio (OR) 2.63, 95% confidence interval (CI): 2.47-2.80) or high-risk score (OR 13.62, 95% CI: 12.12-15.33) was associated with a significantly higher adjusted risk of severe hospitalization.

CONCLUSIONS: Using administrative data, we propose a simple quantitative risk score to measure the severity of CD hospitalizations.

Author List

Ananthakrishnan AN, McGinley EL, Binion DG, Saeian K

Authors

Emily L. McGinley Biostatistician III in the Center for Advancing Population Science department at Medical College of Wisconsin
Kia Saeian MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Area Under Curve
Chi-Square Distribution
Comorbidity
Crohn Disease
Databases, Factual
Female
Hospital Charges
Hospitalization
Humans
International Classification of Diseases
Male
Regression Analysis
Risk Adjustment
Risk Assessment
Severity of Illness Index
United States