2.develop and validate a prospectively applicable comorbidity index for classifying PsA patients according to their comorbid conditions.The two most widely used scores for predicting IHM by International Classification of Diseases (ICD) codes are the Elixhauser (EI) and the Charlson.tion of Disease codes for chronic diagnoses were in any of the 30 Elixhauser comorbidity groups. Identify comorbidities with greatest impact on PsA patients’ health status. For convenience, the user documentation for the Elixhauser Comorbidity Software Refined. Elixhauser Comorbidity Software Refined Tool, v2021.1 (ZIP file, 1.4 MB) released 10/23/20. Elixhauser Comorbidity Software Refined for ICD-10-CM v2021.1: Fiscal Year 2021, Released October 2020 - valid for ICD-10-CM diagnosis codes through September 2021.
Arrhythmias were identified using ICD-9-CM codes (Online Supplement Table).Results: PsA patients who had higher incidence of comorbid condition and were at high risk of hospitalization were men, with older age at disease onset, high BMI (p 6 weeks, or remittent pain involving any finger and/or toe for 3 months. Internal and external validation were carried out.Elixhauser comorbidity score (adjusted OR:1.10 95CI:1.021.18 p 0.016). A weighted index that was developed in a cohort of 1707 PsA patients. Outcomes of interest included functional ability, quality of life, medications induced complications, hospitalization/death. The Charlson score was determined using ICD-9 and ICD-10 diagnostic codes Methods: This was a retrospective multicenter cohort analysis of PsA patients in a rheumatology clinical registry, assessing the effect of different comorbidities measured at patients’ visits over 10-years period. The model using the Elixhauser comorbidity score with a logistic model using the total Charlson score.
The total score is a simple sum of the scores. It encompasses 68 tender and 66 swollen joints count, scores for pain and patient global assessment a well as C-reactive protein level. Smoking status was defined.Disease Activity measures: Disease Activity for Psoriatic Arthritis (DAPSA) was used as composite measure to assess the PsA disease activity. Patients who missed 2 consecutive appointments, were excluded from the work and statistical analysis.Body mass index (BMI) was calculated from measures taken during the patient’s outpatient appointments and categorized per WHO criteria as ‘normal’, ‘overweight’ and ‘obese’. To minimize the potential of missing data, patients who missed their appointment were contacted a new follow up appointment was set up.
Enthesitis was assessed using the Maastricht Ankylosing Spondylitis Entheses Score (MASES). PASI score 20 was considered as severe. Skin affection was assessed using both they included Body Surface Area (BSA) , and Psoriasis Area and Severity Index (PASI).
One off intra-muscular bridge steroid injection was considered on starting sDMARD therapy as a bridge therapy. Unless there was a contraindication, the patients with inflammatory PsA started their sDMARDs therapy once the diagnosis was confirmed. Treatment protocolAll the patients were treated according to a study protocol based on approved international guidelines. Dactylitis was recorded as present or absent.
Comorbidity AssessmentScreening for comorbidities was initially carried out as part of the PROMs self-administered questionnaire. Follow up and database recording: Using “Electronic Outcome Measures for Inflammatory arthritis and spondylo-Arthritis/ EROMIA) , each patient’s visit data were recorded. The patients had the option of contacting the advice line and urgent assessments in the clinic were arranged whenever indicated. Switching bDMARD therapy was considered if the patient sustained untoward side effects, or showed no significant response in their DAPSA and PASI scores.
For colon cancer, optimal monitoring was dependent on the presence of risk factors: all patients older than 50 years were considered as optimally monitored if they had been tested for faecal occult blood at least once during the past 2-years however, patients with at least one risk factor for colorectal cancer (a history of IBD, a family history of colon cancer or a family history of adenomatous polyposis) were only considered as optimally monitored if they had undergone a colonoscopy at least once. For cervix cancer screening, population at risk were women of all ages with no past history of cervix cancer they were considered as optimally monitored if they had received a cervical smear test within the past 3 years. For breast cancer, individuals at risk were (a) women older than 50 years with no history of breast cancer and (b) women of all ages with no personal history of breast cancer but with a family history of breast cancer both groups were considered as optimally monitored if they had received a mammogram during the past 2 years. Cancer: for each cancer, optimal monitoring was determined only for the population at risk (depending on the gender and age), according to each cancer screening recommendation. Infections: a patient was considered as optimally monitored (a) if dental examination had been conducted in the prior year (b) for patients aged >65 years or receiving bDMARDs, they were considered as optimally vaccinated if they had received an influenza vaccination within the past 12 months and a pneumococcal vaccination within the past 5 years and (c) for patients ever exposed to bDMARD, they were considered as optimally screened for viral hepatitis (HBV and HCV) if they had ever been screened.
The was carried out by assessment of the relative risk estimates of the proportional regression model to predict mortality using clinical data as well as the outcomes of interest.Criterion validity is the extent to which the new index correlates with an existing one with the same construct. Validation and comparative assessmentContent Validity refers to the extent to which a measure covers all facets of a given construct. Linear regression was carried out using functional disability as the dependent variable. Outcome of interest: The PsACI was assessed for impact on 4 outcomes: Functional ability, quality of life, medications induced complications, hospitalization and death.
Along the 10-years follow up emerging comorbidities were recorded in the patient file and included in the current study database. Univariate analysis assessing the relationship between different comorbidities and disease parameters, functional disability, quality of life, medication induced complications and hospitalization / death was conducted using student t- test and chi-squared test for continuous and categorical data respectively. Statistical AnalysisBurden of comorbidities was described as frequency and 95% confidence intervals of different comorbidities among the PsO and PsA patients, cohort. The relation of developed comorbidity index was assessing in comparison with HRQoL (functional disability and quality of life) at year 3, 5 and 10 using linear regression and compared predicted versus observed values.External validation of the developed PsACI was tested in 452 PsA patients included in another cross sectional observational study. Predictive validity refers to the degree the new index predicts functional disability and quality of life as well as hospitalization/ death in the future.
Different coordinates of ROC curve were revised to select the cutoff point giving the highest sensitivity and specificity. The proposed comorbidity score was internally validated using ROC curve. Summing up all the assigned score for different comorbidities and disease parameters, a total comorbidity score is calculated for each patient. The assigned score was multiplied by 1 if the comorbid condition or the disease parameter was present and by 0 if not. Regression coefficient of each of those variables was rounded to the nearest 0.5 number to obtain the weight of each of those predictors in the form of a score.
0 kommentar(er)
