ArticleJMA journal2025
Children Comorbidity Score, a Simple Predictor for In-hospital Mortality: A Nationwide Inpatient Database Study in Japan.
Article in JMA journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Utilizing a nationwide inpatient database in Japan, we aimed to develop a novel comorbidity score for pediatric patients to predict in-hospital mortality-the Children Comorbidity Score (CCS)-based on the International Classification of Diseases, 10th Revision (ICD-10) codes. Methods: We retrospectively analyzed pediatric patients hospitalized between 2010 and 2017 using the Japanese Diagnosis Procedure Combination database. Eighty percent of the data was used as a training set, where we applied Lasso regression to a model with 56 candidate comorbidity categories to predict in-hospital mortality. We employed the 1-standard-error rule in Lasso regression to derive a parsimonious model and forced the entry of 12 categories of pediatric Complex Chronic Conditions (CCC). Thus, we developed the CCS, an integer-based comorbidity score using the selected variables with nonzero coefficients. The remaining 20% of the data was used as the test set, where we evaluated the CCS's predictive performance using C-statistics, calibration, and decision curve analysis, comparing it with two other scores: a CCC-based score using ICD-10 codes and the Charlson Comorbidity Index (CCI). Results: Among 1,968,960 pediatric patients, we observed 6,492 (0.33%) in-hospital mortalities. The developed integer-based CCS, utilizing 10 comorbidity categories via variable selection by Lasso regression, had better discrimination ability (C-statistics, 0.720 [95% confidence intervals (CI), 0.707-0.734]) than the CCC (0.649 [0.636-0.662]) and CCI (0.544 [0.533-0.555]). The superior discrimination of the CCS was consistent across all age categories, sexes, and body mass index categories. The CCS showed good calibration, with a calibration slope of 1.027 (95% CI, 0.981-1.073). Decision curve analysis indicated that the CCS provided the highest net benefit compared to either of the reference models. Conclusions: The ICD-10-based CCS outperformed conventional comorbidity scores in predicting in-hospital mortality and would be useful in comorbidity assessment among pediatric inpatients.
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