Development of a new predictive model for polypathological patients. The PROFUND index
Development of a new predictive model for polypathological patients. The PROFUND index
复制标题
DOI：
10.1016/j.ejim.2010.11.012
复制
发表时间：
2011-06-01
影响因子：
8
通讯作者：
Fernandez-Moyano, A.
中科院分区：
文献类型：
--
作者：
Bernabeu-Wittel, M.;Ollero-Baturone, M.;Fernandez-Moyano, A.
背景：当将现有的预后指标应用于多发病理患者（PP）的紧急人群时，人们担心这些指标的准确性。方法：为了建立PP的1年死亡率预测指标，我们开展了一项多中心前瞻性队列研究，招募了来自33家医院的出院、门诊或家庭住院后的1.632名PP。在1.525名完成随访的PP中获得潜在危险因素。对衍生队列（来自西方医院的757名PP）中与死亡率独立相关的每个因素赋予权重，并通过将每个因素的点数相加来计算风险评分。通过风险四分位数校准评估验证队列（来自东部医院的768名患者）的准确性，并通过ROC曲线评估识别能力。最后，将该指数与Charlson指数的准确性进行了比较。结果：衍生/验证队列的死亡率分别为35%/39.5%。确定了9个独立的死亡率预测指标（年龄>= 85岁，3分；无照顾者或配偶以外的照顾者，2分；活动性肿瘤，6分；痴呆，3分；NYHA和/或MRC III-IV功能等级，3分；最后一次住院时谵妄，3分；血红蛋白血症= 11分）。在推导/验证队列中校准良好，曲线下面积的鉴别能力为0.77/0.7。Charlson指数校正效果良好，但识别能力不理想（曲线下面积为0.59）。结论：该预后指标为PP患者1年死亡风险分层提供了一种准确且可转移的方法。(C) 2010年欧洲内科学联合会。Elsevier b.v.版权所有。
Background: There is a concern about the accuracy of the available prognostic indexes when applying them to the emergent population of polypathological patients (PP).Methods: To develop a 1-year mortality predictive index on PP, we developed a multicenter prospective cohort-study recruiting 1.632 PP after hospital discharge, outpatient clinics, or home hospitalization, from 33 hospitals. Potential risk factors were obtained in the 1.525 PP who completed follow-up. Each factor independently associated with mortality in the derivation cohort (757 PP from western hospitals) was assigned a weight, and risk scores were calculated by adding the points of each factor. Accuracy was assessed in the validation cohort (768 PP from eastern hospitals) by risk quartiles calibration, and discrimination power, by ROC curves. Finally, accuracy of the index was compared with that of the Charlson index.Results: Mortality in the derivation/validation cohorts was 35%/39.5%, respectively. Nine independent mortality predictors were identified to create the index (age >= 85 years, 3points; No caregiver or caregiver other than spouse, 2points; active neoplasia, 6points; dementia, 3points; III-IV functional class on NYHA and/or MRC, 3points; delirium during last hospital admission, 3points; hemoglobinemia = 11points, respectively. Calibration was good in derivation/validation cohorts, and discrimination power by area under the curve was 0.77/0.7. Calibration of the Charlson index was good, but discrimination power was suboptimal (area under the curve, 0.59).Conclusions: This prognostic index provides an accurate and transportable method of stratifying 1-year death risk in PP. (C) 2010 European Federation of Internal Medicine. Published by Elsevier B. V. All rights reserved.