Highlights
- •The PROFUND index stratifies 12-month mortality risk of polypathological patients.
- •This index maintains its accuracy over a 4-year follow-up period.
- •The PROFUND index is useful for deciding interventions in polypathological patients.
Abstract
Background/objectives
The PROFUND index stratifies accurately the 12-month mortality risk of polypathological
patients (PPs), but its fitness over a longer follow-up period remains unknown. We
aimed to explore the calibration and discrimination power of PROFUND index over 4-years,
in order to assess its follow-up interval generalizability.
Design
Multicenter prospective cohort-study.
Setting
33 Spanish hospitals.
Participants
PPs included after hospital discharge, outpatient clinics, or home hospitalization.
Measurements
Mortality over a 4-year follow-up period.
Methods
PROFUND index calibration was assessed by risk-quartiles predicted/observed mortality
(Hosmer–Lemeshow goodness-of-fit test), and its discrimination power by ROC curves.
Results
A total of 768 patients were included (630 [82%] of them completed the 4-year follow-up).
Global mortality rate was 63.5%. When assessing individual patient scores, mortality
was 52% in the lowest risk group (0–2 points in PROFUND score); 73.5% in the low-intermediate
risk group (3–6 points), 85% in the intermediate-high group (7–10 points); and 92%
in the highest risk group (≥11 points). Accuracy testing of the PROFUND index showed good calibration (P = .8 in the Hosmer–Lemeshow goodness-of-fit test), and also a good discrimination power
(AUC = 0.71 [0.67–0.77] in ROC curve).
Conclusions
The PROFUND index maintained its accuracy in predicting mortality of polypathological
patients over a 4-year follow-up period. This index may be of potential usefulness
in deciding the most appropriate health-care interventions in populations with multimorbidity.
Keywords
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Article info
Publication history
Published online: August 01, 2016
Accepted:
July 22,
2016
Received in revised form:
July 16,
2016
Received:
May 9,
2016
Identification
Copyright
© 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
