Tsai-Chung Li1, Chia-Ing Li2, Chiu-Shong Liu3, Wen-Yuan Lin4, Chih-Hsueh Lin4, Sing-Yu Yang5, Jen-Huai Chiang6, Cheng-Chieh Lin7. 1. Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan. 2. School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan. 3. School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan. 4. School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan. 5. Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan. 6. Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan. 7. School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan. Electronic address: cclin@mail.cmuh.org.tw.
Abstract
OBJECTIVES: Diabetes is a major cause of hospitalization and in-hospital mortality. However, a scoring system that can be used to identify diabetic patients at risk of diabetes-related hospitalization and in-hospital mortality is lacking. METHODS: We included 32,653 patients in this retrospective cohort study. All recruited patients had type 2 diabetes, were 30-84 years of age, and were enrolled in the National Diabetes Care Management Program over the period of 2001-2003. We used the Cox proportional hazard regression model to derive risk scores. The predictive accuracy of the models was evaluated using receiver operating characteristic curves. We conducted the Hosmer-Lemeshow test to assess the agreement between predicted and observed risks. RESULTS: Over a follow-up period of eight years, 6243 patients were hospitalized for diabetes-related events, and 2048 deaths were registered in hospital records. For the one-, three-, five-, and eight-year periods, the areas under the curve (AUC) for diabetes-related hospitalization in the validation set were 0.80, 077, 0.76, and 0.74, respectively. The corresponding values for in-hospital mortality in the validation set were 0.87, 080, 0.77, and 0.76. The goodness-of-fit test showed that the predicted and observed probabilities in the one-, three-, five-, and eight-year periods were similar for diabetes-related hospitalization and in-hospital mortality in the validation set (all p values > 0.05). CONCLUSION: We developed models for the estimation of the risks of diabetes-related hospitalization and in-hospital mortality in patients with type 2 diabetes. The models may be used to identify diabetic patients who are at high risk for hospital admission and in-hospital mortality.
OBJECTIVES:Diabetes is a major cause of hospitalization and in-hospital mortality. However, a scoring system that can be used to identify diabeticpatients at risk of diabetes-related hospitalization and in-hospital mortality is lacking. METHODS: We included 32,653 patients in this retrospective cohort study. All recruited patients had type 2 diabetes, were 30-84 years of age, and were enrolled in the National Diabetes Care Management Program over the period of 2001-2003. We used the Cox proportional hazard regression model to derive risk scores. The predictive accuracy of the models was evaluated using receiver operating characteristic curves. We conducted the Hosmer-Lemeshow test to assess the agreement between predicted and observed risks. RESULTS: Over a follow-up period of eight years, 6243 patients were hospitalized for diabetes-related events, and 2048 deaths were registered in hospital records. For the one-, three-, five-, and eight-year periods, the areas under the curve (AUC) for diabetes-related hospitalization in the validation set were 0.80, 077, 0.76, and 0.74, respectively. The corresponding values for in-hospital mortality in the validation set were 0.87, 080, 0.77, and 0.76. The goodness-of-fit test showed that the predicted and observed probabilities in the one-, three-, five-, and eight-year periods were similar for diabetes-related hospitalization and in-hospital mortality in the validation set (all p values > 0.05). CONCLUSION: We developed models for the estimation of the risks of diabetes-related hospitalization and in-hospital mortality in patients with type 2 diabetes. The models may be used to identify diabeticpatients who are at high risk for hospital admission and in-hospital mortality.