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Validation of PROFUND prognostic index over a four-year follow-up period

Published:August 01, 2016DOI:https://doi.org/10.1016/j.ejim.2016.07.022

      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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