Design and validation of a predictive model for 1-year hospital admission in HIV patients on antiretroviral treatment

Abstract

ObjectivesTo develop and validate a model for predicting the risk of hospital admission within 1 year in the HIV population under antiretroviral treatment.MethodsWe conducted a retrospective observational study. Patients receiving antiretroviral treatment for at least 1 year who were followed by the pharmacy service in a Spanish-speaking hospital between January 2008 and December 2012 were included. Demographics, and clinical and pharmacotherapy variables, were included in the model design. To find prognostic factors for hospital admission a multivariate logistic regression model was created after performing a univariate analysis. Model validity was determined by the shrinkage method and the model discrimination by Harrell's C-index.Results442 patients were included in the study. The variables ‘CD4 count <200 (cells/µL)’, ‘drug/alcohol use’, ‘detectable viral load (>50 copies/mL)’, ‘number of previous admissions’, and ‘number of drugs different from antiretroviral treatment’ were the independent predictors of risk of hospital admission. Probabilities predicted by the model showed an R2=0.98 for the development sample and an R2=0.86 for the validation sample. The Harrell's C index for the development and validation data were 0.82 (95% CI 0.77 to 0.87) and 0.80 (95% CI 0.73 to 0.88), respectively.ConclusionsThe model developed in this study may be useful in daily practice for identifying HIV patients at high risk of 1-year hospital admission.

Influence of CMO pharmaceutical care model-based intervention on readmission rate in high risk HIV patients: the INFARDAR study

“…These results may not apply to hospitals lacking electronic medical records or those without any outpatient care data. Nonetheless, the Montes-Escalante et al [18] prediction tool, in considering easy to collect potential predictors, we favored the selection of elements that would be reasonably available.…”

“…At discharge, patients included were classified according to the risk of readmission as high or low risk. It was calculated through the tool published by Montes-Escalante IM et al [18]. This is a mathematical model for predicting risk of hospital readmission within 1 year in PLWHIV and defined by: Prob =1/(1+e−Z) where Z=−14 857+1744×hospital admissions the year before + 02 663×number of co-medications + 0771×detectable HIV viral load (copies/mL) +13 584×alcohol or drug use + 11 376×CD4 count (<200 cells/µL).…”