Abstract：
All patient refined-diagnosis related groups (APR-DRGs) includes severity of illness (SOI) and risk of mortality (ROM) subclasses. For predictions, both subscales are used together or interchangeably. We aimed to compare SOI and ROM by evaluating the reliability and agreement between both. We performed a retrospective observational study using mainland Portuguese public hospitalisations of adult patients from 2011 to 2016. Reliability (quadratic weighted kappa) and agreement (proportion of agreement) between SOI and ROM were analysed overall and by APR-DRG. While overall reliability and agreement between SOI and ROM were high (weighted kappa: 0.717, 95% CI 0.717-0.718; proportion of agreement: 69.0%, 95% CI 69.0-69.0) there was high heterogeneity across APR-DRGs, ranging from 0.016 to 0.846 on reliability and from 23.1% to 94.8% on agreement. Most of APR-DRGs (263 out of 284) showed a higher proportion of episodes with ROM level above the SOI level than the opposite. In conclusion, SOI and Risk of Mortality measures must be clearly distinguished and are \'two scales of different concepts\' rather than \'two sides of the same coin\'. However, this is more evident for some APR-DRGs than for others.
摘要：
所有患者精细诊断相关组（APR-DRGs）包括疾病严重程度（SOI）和死亡风险（ROM）亚类。对于预测，两个分量表一起使用或互换使用。我们旨在通过评估SOI和ROM之间的可靠性和一致性来比较两者。我们在2011年至2016年期间使用葡萄牙大陆公立医院的成年患者进行了一项回顾性观察性研究。总体上并通过APR-DRG分析了SOI和ROM之间的可靠性（二次加权kappa）和协议（协议比例）。虽然SOI和ROM之间的总体可靠性和一致性很高(加权kappa:0.717，95%CI0.717-0.718；协议比例:69.0%，95%CI69.0-69.0)在APR-DRG之间存在高度异质性，可靠性从0.016到0.846，协议从23.1%到94.8%。大多数APR-DRG（284个中的263个）显示出ROM水平高于SOI水平的发作比例高于相反。总之,SOI和死亡率风险测量必须明确区分，是“两个不同概念的尺度”，而不是“同一枚硬币的两面”。然而,这对于一些APR-DRG来说比其他更明显。
