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CRONIGAL: Prognostic index for chronic patients after hospital admission

Published:October 10, 2016DOI:https://doi.org/10.1016/j.ejim.2016.08.002

      Highlights

      • We have described the prognostic variables in a group of chronic patients.
      • With these variables we have developed a prognostic index: CRONIGAL Index.
      • The CRONIGAL Index includes 7 variables and has turned out to be a good predictor of mortality.
      • The CRONIGAL Index is useful for all chronic patients including polipathological.

      Abstract

      Objective

      We have followed patients admitted to a Polypathology and Advanced Age Unit for two years in order to identify the variables that best define the mortality prognosis at medium-term (1–2 years) for chronic and polypathological patients requiring admission at an Internal Medicine Department.

      Methods

      This is an observational, prospective study in clinical practice. Polypathological, chronic or multimorbidity patients were included. The classification of the Spanish Ministry for Health was used in order to classify patients as chronic or polypathological. The Charlson Index and Barthel Index were estimated and the Pfeiffer test was administered. The Spanish PROFUND Index was also used. Logistic regression models and Cox proportional hazard model were built in order to study the influence of prognostic factors on survival.

      Results

      A total of 567 patients were included: 333 met polypathological (PPP) criteria and 234 chronic criteria (CC). Mean age was 84.8 + 7.3 years. A total of 469 were followed up, most patients belonged to category E (282), 174 to category A and 118 to category C. The prognosis at one year of our patients can be estimated with 7 variables: age, neoplasia, delirium, Barthel, Pfeiffer, presence of atrial fibrillation, and creatinine. The area under the curve is 0.74.

      Conclusion

      The variables dementia, neoplasia, delirium at admission, Barthel Index under 60, or deceased spouse have mortality prognosis value at one or two years. An index with 7 variables applicable to chronic and polypathological patients after admission may serve as tool to better manage complex chronic patients and follow them up.

      Keywords

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