Lasso回归分析影响肝衰竭患者DRGs分组的疾病谱研究  

Study on the Disease Spectrum Affecting DRG Grouping in Patients with Liver Failure using Lasso Regression Analysis

作　　者：万钢 李磊 马静 王佳静 于景祎 王中菲 陈美玲 Wan Gang;Li Lei;Ma Jing;Wang Jiajing;Yu Jingyi;Wang Zhongfei;Chen Meiling(National Center for Infectious Diseases(Beijing),Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China;不详)

机构地区：[1]首都医科大学附属北京地坛医院,国家传染病医学中心(北京),北京市100015

出　　处：《中国病案》2025年第3期55-58,共4页Chinese Medical Record

摘　　要：目的分析肝衰竭住院患者的疾病诊断相关分组情况,并探讨影响其DRGs分组的重要疾病谱,以期为肝衰竭病种DRGs管理提供参考。方法某院2023年1月1日—2023年12月31日主要诊断为肝衰竭、肝功能衰竭、重型肝炎的1242例住院患者,采集患者的性别、年龄、主要诊断ICD编码、其他诊断ICD编码、离院方式、住院天数、总费用等病案首页信息;在北京地区住院医疗服务绩效平台中下载2023年所有肝衰竭患者的DRGs分组信息,共纳入1005例内科治疗肝衰竭患者。采用Lasso回归筛选对分组有影响的疾病谱,采用帕累托图选择影响分组的重要疾病。结果与HS15组相比较,HS11组患者男性比例高、年龄更大、非医嘱离院或死亡比例高、住院费用高,组间差异有统计学意义。低蛋白血症、腹水、肝硬化失代偿期、脾功能亢进等为肝衰竭患者常见的合并疾病。Lasso回归分析筛选出103个影响DRGs分组的疾病,Lasso评分的曲线下面积为1.00(95%CI:1.00~1.00),校正曲线显示Lasso回归分析准确度较高;帕累托图显示26种疾病影响分组结果的80%。结论凝血功能障碍、凝血功能异常、全血细胞减少、肾功能不全、心功能不全、真菌感染、肺动脉高压、急性肾功能不全、脓毒性休克等疾病为影响肝衰竭患者DRGs分组的重要疾病谱。Objectives This study aims to analyze the disease-related grouping of hospitalized patients with liver failure and explore the important disease spectrum that affects their DRG groups,so as to provide a basis for DRG management of liver failure diseases.Methods From January 1,2023 to December 31,2023,1,242 inpatients in a certain hospital were diagnosed with liver failure,liver function failure,and severe hepatitis.The patients'gender,age,ICD code of the main diagnosis,ICD code of other diagnoses,discharge method,length of hospital stay,total cost and other medical record front-page information were collected.The DRG grouping information of all patients with liver failure in 2023 was downloaded from the Beijing Inpatient Medical Service Performance Platform,and a total of 1005 patients with liver failure receiving medical treatment were included.Lasso regression was used to screen the disease spectrum that affected the grouping,and Pareto chart was used to select important diseases that affected the grouping.Results Compared with HS15 group,the proportion of male patients in HS11 group was higher,the average age was older,the proportion of non-medical leave or death was higher,and the hospitalization cost was higher.The difference between the groups was statistically significant.The hypoalbuminemia,ascites,decompensated cirrhosis,and splenic hyperfunction were common comorbidities in patients with liver failure.Lasso regression analysis screened 103 diseases that had an impact on clinical prognosis.The area under the curve of the Lasso score was 1.00(95%CI:1.00-1.00),and the calibration curve showed that the Lasso regression analysis had a high accuracy;the Pareto chart showed that 26 diseases affected 80% of the grouping results.Conclusions Coagulation dysfunction,abnormal coagulation function,decreased whole blood cells,renal insufficiency,cardiac insufficiency,fungal infection,pulmonary hypertension,acute renal insufficiency,septic shock and other diseases are important disease spectra that affect the grouping

关 键 词：肝衰竭 Lasso回归 疾病相关分组 疾病谱 

分 类 号：R575.3[医药卫生—消化系统]