Development of a Comorbidity Index for Use in Obstetric Patients
OBJECTIVE:To develop and validate a maternal comorbidity index to predict severe maternal morbidity, defined as the occurrence of acute maternal end-organ injury, or mortality. METHODS:Data were derived from the Medicaid Analytic eXtract for the years 2000–2007. The primary outcome was defined as th...
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| Veröffentlicht in: | Obstetrics and gynecology (New York. 1953) 2013-11, Vol.122 (5), p.957-965 |
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| container_title | Obstetrics and gynecology (New York. 1953) |
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| creator | Bateman, Brian T. Mhyre, Jill M. Hernandez-Diaz, Sonia Huybrechts, Krista F. Fischer, Michael A. Creanga, Andreea A. Callaghan, William M. Gagne, Joshua J. |
| description | OBJECTIVE:To develop and validate a maternal comorbidity index to predict severe maternal morbidity, defined as the occurrence of acute maternal end-organ injury, or mortality.
METHODS:Data were derived from the Medicaid Analytic eXtract for the years 2000–2007. The primary outcome was defined as the occurrence of maternal end-organ injury or death during the delivery hospitalization through 30 days postpartum. The data set was randomly divided into a two-thirds development cohort and a one-third validation cohort. Using the development cohort, a logistic regression model predicting the primary outcome was created using a stepwise selection algorithm that included 24-candidate comorbid conditions and maternal age. Each of the conditions included in the final model was assigned a weight based on its beta coefficient, and these were used to calculate a maternal comorbidity index.
RESULTS:The cohort included 854,823 completed pregnancies, of which 9,901 (1.2%) were complicated by the primary study outcome. The derived score included 20 maternal conditions and maternal age. For each point increase in the score, the odds ratio for the primary outcome was 1.37 (95% confidence interval [CI] 1.35–1.39). The c-statistic for this model was 0.657 (95% CI 0.647–0.666). The derived score performed significantly better than available comorbidity indices in predicting maternal morbidity and mortality.
CONCLUSION:This new maternal comorbidity index provides a simple measure for summarizing the burden of maternal illness for use in the conduct of epidemiologic, health services, and comparative effectiveness research.
LEVEL OF EVIDENCE:II |
| doi_str_mv | 10.1097/AOG.0b013e3182a603bb |
| format | Article |
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METHODS:Data were derived from the Medicaid Analytic eXtract for the years 2000–2007. The primary outcome was defined as the occurrence of maternal end-organ injury or death during the delivery hospitalization through 30 days postpartum. The data set was randomly divided into a two-thirds development cohort and a one-third validation cohort. Using the development cohort, a logistic regression model predicting the primary outcome was created using a stepwise selection algorithm that included 24-candidate comorbid conditions and maternal age. Each of the conditions included in the final model was assigned a weight based on its beta coefficient, and these were used to calculate a maternal comorbidity index.
RESULTS:The cohort included 854,823 completed pregnancies, of which 9,901 (1.2%) were complicated by the primary study outcome. The derived score included 20 maternal conditions and maternal age. For each point increase in the score, the odds ratio for the primary outcome was 1.37 (95% confidence interval [CI] 1.35–1.39). The c-statistic for this model was 0.657 (95% CI 0.647–0.666). The derived score performed significantly better than available comorbidity indices in predicting maternal morbidity and mortality.
CONCLUSION:This new maternal comorbidity index provides a simple measure for summarizing the burden of maternal illness for use in the conduct of epidemiologic, health services, and comparative effectiveness research.
LEVEL OF EVIDENCE:II</description><identifier>ISSN: 0029-7844</identifier><identifier>EISSN: 1873-233X</identifier><identifier>DOI: 10.1097/AOG.0b013e3182a603bb</identifier><identifier>PMID: 24104771</identifier><language>eng</language><publisher>United States: by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved</publisher><subject>Acute Disease - mortality ; Adolescent ; Adult ; Cohort Studies ; Comorbidity ; Delivery, Obstetric - mortality ; Disseminated Intravascular Coagulation - mortality ; Female ; Heart Failure - mortality ; Humans ; Logistic Models ; Medicaid - statistics & numerical data ; Middle Aged ; Postpartum Period ; Pregnancy ; Pregnancy Complications - mortality ; Reproducibility of Results ; Risk Assessment ; Sepsis - mortality ; Severity of Illness Index ; United States ; Young Adult</subject><ispartof>Obstetrics and gynecology (New York. 1953), 2013-11, Vol.122 (5), p.957-965</ispartof><rights>by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.</rights><rights>2013 by The American College of Obstetricians and Gynecologists.</rights><rights>Copyright 2013 American College of Obstetricians and Gynecologists. 2013</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c568b-981681723a45f70527f455f2946ffef3151804dbedbc36ddde6564ffda24ee5e3</citedby><cites>FETCH-LOGICAL-c568b-981681723a45f70527f455f2946ffef3151804dbedbc36ddde6564ffda24ee5e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24104771$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bateman, Brian T.</creatorcontrib><creatorcontrib>Mhyre, Jill M.</creatorcontrib><creatorcontrib>Hernandez-Diaz, Sonia</creatorcontrib><creatorcontrib>Huybrechts, Krista F.</creatorcontrib><creatorcontrib>Fischer, Michael A.</creatorcontrib><creatorcontrib>Creanga, Andreea A.</creatorcontrib><creatorcontrib>Callaghan, William M.</creatorcontrib><creatorcontrib>Gagne, Joshua J.</creatorcontrib><title>Development of a Comorbidity Index for Use in Obstetric Patients</title><title>Obstetrics and gynecology (New York. 1953)</title><addtitle>Obstet Gynecol</addtitle><description>OBJECTIVE:To develop and validate a maternal comorbidity index to predict severe maternal morbidity, defined as the occurrence of acute maternal end-organ injury, or mortality.
METHODS:Data were derived from the Medicaid Analytic eXtract for the years 2000–2007. The primary outcome was defined as the occurrence of maternal end-organ injury or death during the delivery hospitalization through 30 days postpartum. The data set was randomly divided into a two-thirds development cohort and a one-third validation cohort. Using the development cohort, a logistic regression model predicting the primary outcome was created using a stepwise selection algorithm that included 24-candidate comorbid conditions and maternal age. Each of the conditions included in the final model was assigned a weight based on its beta coefficient, and these were used to calculate a maternal comorbidity index.
RESULTS:The cohort included 854,823 completed pregnancies, of which 9,901 (1.2%) were complicated by the primary study outcome. The derived score included 20 maternal conditions and maternal age. For each point increase in the score, the odds ratio for the primary outcome was 1.37 (95% confidence interval [CI] 1.35–1.39). The c-statistic for this model was 0.657 (95% CI 0.647–0.666). The derived score performed significantly better than available comorbidity indices in predicting maternal morbidity and mortality.
CONCLUSION:This new maternal comorbidity index provides a simple measure for summarizing the burden of maternal illness for use in the conduct of epidemiologic, health services, and comparative effectiveness research.
LEVEL OF EVIDENCE:II</description><subject>Acute Disease - mortality</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Cohort Studies</subject><subject>Comorbidity</subject><subject>Delivery, Obstetric - mortality</subject><subject>Disseminated Intravascular Coagulation - mortality</subject><subject>Female</subject><subject>Heart Failure - mortality</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Medicaid - statistics & numerical data</subject><subject>Middle Aged</subject><subject>Postpartum Period</subject><subject>Pregnancy</subject><subject>Pregnancy Complications - mortality</subject><subject>Reproducibility of Results</subject><subject>Risk Assessment</subject><subject>Sepsis - mortality</subject><subject>Severity of Illness Index</subject><subject>United States</subject><subject>Young Adult</subject><issn>0029-7844</issn><issn>1873-233X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU9PFTEUxRsjkSf6DYzp0s1A_09nYyQPQRKS50ISd007vfVVZ6bPdh7It6f4gKALXTW3Pb9zmnMRekPJISVde3S8OjskjlAOnGpmFeHOPUMLqlveMM6_PkcLQljXtFqIffSylO-EEKo6_gLtM0GJaFu6QB9O4AqGtBlhmnEK2OJlGlN20cf5Bp9PHn7hkDK-LIDjhFeuzDDn2OPPdo6VKa_QXrBDgdf35wG6PP34ZfmpuVidnS-PL5peKu2aTlOlacu4FTK0RLI2CCkD64QKAQKnkmoivAPveq6896CkEiF4ywSABH6A3u98N1s3gu9rdraD2eQ42nxjko3mz5cprs23dGW4Zh3tumrw7t4gp59bKLMZY-lhGOwEaVsMFULomqnupGIn7XMqJUN4jKHE3JVvavnm7_Ir9vbpFx-hh7arQO8E12mYIZcfw_YaslmDHeb1_7zFP9C6WaKYJA2rGKV1an5f8VtJ0KPY</recordid><startdate>20131101</startdate><enddate>20131101</enddate><creator>Bateman, Brian T.</creator><creator>Mhyre, Jill M.</creator><creator>Hernandez-Diaz, Sonia</creator><creator>Huybrechts, Krista F.</creator><creator>Fischer, Michael A.</creator><creator>Creanga, Andreea A.</creator><creator>Callaghan, William M.</creator><creator>Gagne, Joshua J.</creator><general>by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved</general><general>by The American College of Obstetricians and Gynecologists</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20131101</creationdate><title>Development of a Comorbidity Index for Use in Obstetric Patients</title><author>Bateman, Brian T. ; Mhyre, Jill M. ; Hernandez-Diaz, Sonia ; Huybrechts, Krista F. ; Fischer, Michael A. ; Creanga, Andreea A. ; Callaghan, William M. ; Gagne, Joshua J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c568b-981681723a45f70527f455f2946ffef3151804dbedbc36ddde6564ffda24ee5e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Acute Disease - mortality</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Cohort Studies</topic><topic>Comorbidity</topic><topic>Delivery, Obstetric - mortality</topic><topic>Disseminated Intravascular Coagulation - mortality</topic><topic>Female</topic><topic>Heart Failure - mortality</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Medicaid - statistics & numerical data</topic><topic>Middle Aged</topic><topic>Postpartum Period</topic><topic>Pregnancy</topic><topic>Pregnancy Complications - mortality</topic><topic>Reproducibility of Results</topic><topic>Risk Assessment</topic><topic>Sepsis - mortality</topic><topic>Severity of Illness Index</topic><topic>United States</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bateman, Brian T.</creatorcontrib><creatorcontrib>Mhyre, Jill M.</creatorcontrib><creatorcontrib>Hernandez-Diaz, Sonia</creatorcontrib><creatorcontrib>Huybrechts, Krista F.</creatorcontrib><creatorcontrib>Fischer, Michael A.</creatorcontrib><creatorcontrib>Creanga, Andreea A.</creatorcontrib><creatorcontrib>Callaghan, William M.</creatorcontrib><creatorcontrib>Gagne, Joshua J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Obstetrics and gynecology (New York. 1953)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bateman, Brian T.</au><au>Mhyre, Jill M.</au><au>Hernandez-Diaz, Sonia</au><au>Huybrechts, Krista F.</au><au>Fischer, Michael A.</au><au>Creanga, Andreea A.</au><au>Callaghan, William M.</au><au>Gagne, Joshua J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Development of a Comorbidity Index for Use in Obstetric Patients</atitle><jtitle>Obstetrics and gynecology (New York. 1953)</jtitle><addtitle>Obstet Gynecol</addtitle><date>2013-11-01</date><risdate>2013</risdate><volume>122</volume><issue>5</issue><spage>957</spage><epage>965</epage><pages>957-965</pages><issn>0029-7844</issn><eissn>1873-233X</eissn><abstract>OBJECTIVE:To develop and validate a maternal comorbidity index to predict severe maternal morbidity, defined as the occurrence of acute maternal end-organ injury, or mortality.
METHODS:Data were derived from the Medicaid Analytic eXtract for the years 2000–2007. The primary outcome was defined as the occurrence of maternal end-organ injury or death during the delivery hospitalization through 30 days postpartum. The data set was randomly divided into a two-thirds development cohort and a one-third validation cohort. Using the development cohort, a logistic regression model predicting the primary outcome was created using a stepwise selection algorithm that included 24-candidate comorbid conditions and maternal age. Each of the conditions included in the final model was assigned a weight based on its beta coefficient, and these were used to calculate a maternal comorbidity index.
RESULTS:The cohort included 854,823 completed pregnancies, of which 9,901 (1.2%) were complicated by the primary study outcome. The derived score included 20 maternal conditions and maternal age. For each point increase in the score, the odds ratio for the primary outcome was 1.37 (95% confidence interval [CI] 1.35–1.39). The c-statistic for this model was 0.657 (95% CI 0.647–0.666). The derived score performed significantly better than available comorbidity indices in predicting maternal morbidity and mortality.
CONCLUSION:This new maternal comorbidity index provides a simple measure for summarizing the burden of maternal illness for use in the conduct of epidemiologic, health services, and comparative effectiveness research.
LEVEL OF EVIDENCE:II</abstract><cop>United States</cop><pub>by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved</pub><pmid>24104771</pmid><doi>10.1097/AOG.0b013e3182a603bb</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Obstetrics and gynecology (New York. 1953), 2013-11, Vol.122 (5), p.957-965 |
| issn | 0029-7844 1873-233X |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3829199 |
| source | MEDLINE; Journals@Ovid Complete |
| subjects | Acute Disease - mortality Adolescent Adult Cohort Studies Comorbidity Delivery, Obstetric - mortality Disseminated Intravascular Coagulation - mortality Female Heart Failure - mortality Humans Logistic Models Medicaid - statistics & numerical data Middle Aged Postpartum Period Pregnancy Pregnancy Complications - mortality Reproducibility of Results Risk Assessment Sepsis - mortality Severity of Illness Index United States Young Adult |
| title | Development of a Comorbidity Index for Use in Obstetric Patients |
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