1844 ACCURACY OF THE CHARLSON COMORBIDITY INDEX (CCI) IN PREDICTING IN-HOSPITAL MORTALITY (IHM) IN PATIENTS TREATED WITH RADICAL CYSTECTOMY (RC)
Bibliographic record
Abstract
You have accessJournal of UrologyBladder Cancer: Invasive1 Apr 20111844 ACCURACY OF THE CHARLSON COMORBIDITY INDEX (CCI) IN PREDICTING IN-HOSPITAL MORTALITY (IHM) IN PATIENTS TREATED WITH RADICAL CYSTECTOMY (RC) Daniel Liberman, Maxine Sun, Claudio Jeldres, Firas Abdollah, Jan Schmitges, Orchidee Djahangirian, Daniel Pharand, Shahrokh F. Shariat, Paul Perrotte, and Pierre I. Karakiewicz Daniel LibermanDaniel Liberman Montreal, Canada More articles by this author , Maxine SunMaxine Sun Montreal, Canada More articles by this author , Claudio JeldresClaudio Jeldres Montreal, Canada More articles by this author , Firas AbdollahFiras Abdollah Milan, Italy More articles by this author , Jan SchmitgesJan Schmitges Hamburg, Germany More articles by this author , Orchidee DjahangirianOrchidee Djahangirian Montreal, Canada More articles by this author , Daniel PharandDaniel Pharand Montreal, Canada More articles by this author , Shahrokh F. ShariatShahrokh F. Shariat New York, NY More articles by this author , Paul PerrottePaul Perrotte Montreal, Canada More articles by this author , and Pierre I. KarakiewiczPierre I. Karakiewicz Montreal, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1877AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES CCI was developed to predict one-year mortality in medical patients. Currently, its use is widespread in surgical patients, including those treated with RC for urothelial carcinoma of the bladder. However, its accuracy in these patients was never tested. To address this limitation we tested the accuracy of CCI in predicting IHM after RC. METHODS We relied on 12274 RC records for patients treated between 1998 and 2007, within the Nationwide Inpatient Sample. IHM rates were stratified according to CCI. Univariable and multivariable logistic regression analyse tested the independent predictor status of CCI as a determinant of IHM. Predictive accuracy estimates were quantified with the area under the curve (AUC), after 200 bootstrap resamples. RESULTS Average patient age was 68.5 years (median 70, range 40–95). CCI was 0 vs. 1 vs. 2 vs. 3 vs. ≥4 in respectively 68.1 vs. 22.9 vs. 4.9 vs. 3.0 vs. 1.1% of patients. The overall IHM rate was 2.4%, and it was 1.8 vs. 3.1 vs. 4.0 vs. 3.8 vs. 12.7% for patients with CCI of respectively 0 vs. 1 vs. 2 vs. 3 vs. ≥4 (p<0.001). The accuracy of CCI to predict IHM was 59.6% vs. 64.9% for age vs. 49.9% for gender vs. 48.3% for race vs. 52.8% for year of surgery vs. 56.6% for annual hospital volume vs. 54.3% for hospital teaching status. In multivariable analyses, CCI achieved independent predictor status of IHM. The accuracy of the final model was 68.1%. CONCLUSIONS Although CCI is an independent predictor of IHM after RC, its ability to identify individual IHM event is relatively poor, as it misclassifies virtually 40% of IHM events. The consideration of other variables resulted in an important improvement in the ability to predict IHM. In consequence, a RC-specific comorbidity index may be warranted. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185 Issue 4S April 2011 Page: e740 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.Metrics Author Information Daniel Liberman Montreal, Canada More articles by this author Maxine Sun Montreal, Canada More articles by this author Claudio Jeldres Montreal, Canada More articles by this author Firas Abdollah Milan, Italy More articles by this author Jan Schmitges Hamburg, Germany More articles by this author Orchidee Djahangirian Montreal, Canada More articles by this author Daniel Pharand Montreal, Canada More articles by this author Shahrokh F. Shariat New York, NY More articles by this author Paul Perrotte Montreal, Canada More articles by this author Pierre I. Karakiewicz Montreal, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.016 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".