Identifying high-risk hospitalised chronic kidney disease patient using electronic health records for serious illness conversation.
10.47102/annals-acadmedsg.2021427
- Author:
Lee Ying YEOH
1
;
Ying Ying SEOW
;
Hui Cheng TAN
Author Information
1. Department of General Medicine, Sengkang General Hospital, Singapore.
- Publication Type:Journal Article
- MeSH:
Adult;
Aged;
Electronic Health Records;
Hospitalization;
Humans;
Length of Stay;
Renal Insufficiency, Chronic/therapy*;
Retrospective Studies
- From:Annals of the Academy of Medicine, Singapore
2022;51(3):161-169
- CountrySingapore
- Language:English
-
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.
