| アブストラクト | INTRODUCTION: Utilizing a nationwide inpatient database in Japan, we aimed to develop a novel comorbidity score for pediatric patients to predict in-hospital mortality-the Children Comorbidity Score (CCS)-based on the International Classification of Diseases, 10th Revision (ICD-10) codes. METHODS: We retrospectively analyzed pediatric patients hospitalized between 2010 and 2017 using the Japanese Diagnosis Procedure Combination database. Eighty percent of the data was used as a training set, where we applied Lasso regression to a model with 56 candidate comorbidity categories to predict in-hospital mortality. We employed the 1-standard-error rule in Lasso regression to derive a parsimonious model and forced the entry of 12 categories of pediatric Complex Chronic Conditions (CCC). Thus, we developed the CCS, an integer-based comorbidity score using the selected variables with nonzero coefficients. The remaining 20% of the data was used as the test set, where we evaluated the CCS's predictive performance using C-statistics, calibration, and decision curve analysis, comparing it with two other scores: a CCC-based score using ICD-10 codes and the Charlson Comorbidity Index (CCI). RESULTS: Among 1,968,960 pediatric patients, we observed 6,492 (0.33%) in-hospital mortalities. The developed integer-based CCS, utilizing 10 comorbidity categories via variable selection by Lasso regression, had better discrimination ability (C-statistics, 0.720 [95% confidence intervals (CI), 0.707-0.734]) than the CCC (0.649 [0.636-0.662]) and CCI (0.544 [0.533-0.555]). The superior discrimination of the CCS was consistent across all age categories, sexes, and body mass index categories. The CCS showed good calibration, with a calibration slope of 1.027 (95% CI, 0.981-1.073). Decision curve analysis indicated that the CCS provided the highest net benefit compared to either of the reference models. CONCLUSIONS: The ICD-10-based CCS outperformed conventional comorbidity scores in predicting in-hospital mortality and would be useful in comorbidity assessment among pediatric inpatients. |
|---|
| ジャーナル名 | JMA journal |
|---|
| Pubmed追加日 | 2025/5/26 |
|---|
| 投稿者 | Ikeda Kurakawa, Kayo; Okada, Akira; Konishi, Takaaki; Michihata, Nobuaki; Ishimaru, Miho; Matsui, Hiroki; Fushimi, Kiyohide; Yasunaga, Hideo; Yamauchi, Toshimasa; Nangaku, Masaomi; Kadowaki, Takashi; Yamaguchi, Satoko |
|---|
| 組織名 | Department of Prevention of Diabetes and Lifestyle-Related Diseases, The;University of Tokyo, Tokyo, Japan.;Department of Breast and Endocrine Surgery, Graduate School of Medicine, The;Department of Clinical Epidemiology and Health Economics, School of Public;Health, The University of Tokyo, Tokyo, Japan.;Cancer Prevention Center, Chiba Cancer Center Research Institute, Chuo-ku, Japan.;Department of Dental Public Health, Graduate School of Medical and Dental;Sciences, Institute of Science Tokyo, Tokyo, Japan.;Department of Health Policy and Informatics, Institute of Science Tokyo, Tokyo,;Japan.;Department of Diabetes and Metabolism, Graduate School of Medicine, The;Department of Nephrology and Endocrinology, Graduate School of Medicine, The;Toranomon Hospital, Tokyo, Japan. |
|---|
| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/40415997/ |
|---|
