Identifying high-risk hospitalised chronic kidney disease patient using electronic health records for serious illness conversation
Annals of the Academy of Medicine, Singapore
;
: 161-169, 2022.
Article
in English
| WPRIM
| ID: wpr-927463
ABSTRACT
INTRODUCTION@#This study aimed to identify risk factors that are associated with increased mortality that could prompt a serious illness conversation (SIC) among patients with chronic kidney disease (CKD).@*METHODS@#The electronic health records of adult CKD patients admitted between August 2018 and February 2020 were retrospectively reviewed to identify CKD patients with >1 hospitalisation and length of hospital stay ≥4 days. Outcome measures were mortality and the duration of hospitalisation. We also assessed the utility of the Cohen's model to predict 6-month mortality among CKD patients.@*RESULTS@#A total of 442 patients (mean age 68.6 years) with median follow-up of 15.3 months were identified. The mean (standard deviation) Charlson Comorbidity Index [CCI] was 6.8±2.0 with 48.4% on chronic dialysis. The overall mortality rate until August 2020 was 36.7%. Mortality was associated with age (hazard ratio [HR] 1.51, 95% confidence interval [CI] 1.29-1.77), CCI≥7 (1.58, 1.08-2.30), lower serum albumin (1.09, 1.06-1.11), readmission within 30-day (1.96, 1.43-2.68) and CKD non-dialysis (1.52, 1.04-2.17). Subgroup analysis of the patients within first 6-month from index admission revealed longer hospitalisation stay for those who died (CKD-non dialysis 5.5; CKD-dialysis 8.0 versus 4 days for those survived, P<0.001). The Cohen's model demonstrated reasonable predictive ability to discriminate 6-month mortality (area under the curve 0.81, 95% CI 0.75-0.87). Only 24 (5.4%) CKD patients completed advanced care planning.@*CONCLUSION@#CCI, serum albumin and recent hospital readmission could identify CKD patients at higher risk of mortality who could benefit from a serious illness conversation.
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Retrospective Studies
/
Renal Insufficiency, Chronic
/
Electronic Health Records
/
Hospitalization
/
Length of Stay
Type of study:
Etiology study
/
Observational study
/
Prognostic study
/
Risk factors
Limits:
Adult
/
Aged
/
Humans
Language:
English
Journal:
Annals of the Academy of Medicine, Singapore
Year:
2022
Type:
Article
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