Key result
LACE index shows only moderate discrimination for 30-day all-cause readmission with a ~0.64 C-statistic.
Why the study?
Hospital readmissions within 30 days are an indicator of quality of hospital care, but the ability of the LACE index to predict 30-day readmissions in patients hospitalised for community-acquired pneumonia required evaluation.
Does the LACE index accurately predict 30-day all-cause or CAP-specific hospital readmissions in patients with community-acquired pneumonia?
Cohort (n=3,996)
No
Does the LACE index accurately predict 30-day all-cause or CAP-specific hospital readmissions in patients with community-acquired pneumonia?
Effect estimate: C-statistic 0.6395
The LACE index provides only moderate predictive ability for 30-day hospital readmissions in pneumonia patients, indicating that more disease-specific variables are likely necessary to improve readmission prediction in this population.
LACE index should not yet guide readmission risk assessment in CAP; leaves open need for pneumonia-specific predictors.
BACKGROUND AND OBJECTIVE: Hospital readmissions within 30 days are used as an indicator of quality of hospital care. We aimed to evaluate the ability of the LACE (Length of stay, Acuity of admission, Comorbidities based on Charlson comorbidity score and number of Emergency visits in the last 6 months) index to predict the risk of 30-day readmissions in patients hospitalised for community-acquired pneumonia (CAP). METHODS: In this retrospective cohort study a LACE index score was calculated for patients with a principal diagnosis of CAP admitted to a tertiary hospital in Sydney, Australia. The predictive ability of the LACE score for 30-day readmissions was assessed using receiver operator characteristic curves with C-statistic. RESULTS: Of 3996 patients admitted to hospital for CAP at least once, 8.0% (n=327) died in hospital and 14.6% (n=584) were readmitted within 30 days. 17.8% (113 of 636) of all 30-day readmissions were again due to CAP, followed by readmissions for chronic obstructive pulmonary disease, heart failure and chest pain. The LACE index had moderate discriminative ability to predict 30-day readmission (C-statistic=0.6395) but performed poorly for the prediction of 30-day readmissions due to CAP (C-statistic=0.5760). CONCLUSIONS: The ability of the LACE index to predict all-cause 30-day hospital readmissions is comparable to more complex pneumonia-specific indices with moderate discrimination. For the prediction of 30-day readmissions due to CAP, the performance of the LACE index and modified risk prediction models using readily available variables (sex, age, specific comorbidities, after-hours, weekend, winter or summer admission) is insufficient.
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Dobler et al. (2020) conducted a cohort in Community-acquired pneumonia (n=3,996). LACE index score was evaluated on Predictive ability of LACE index for 30-day all-cause readmission (C-statistic 0.6395). The LACE index had moderate discriminative ability for predicting 30-day all-cause hospital readmission with a C-statistic of 0.6395, but performed poorly for predicting CAP-specific 30-day readmissions (C-statistic 0.5760).
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