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A one-year risk score to predict all-cause mortality in hypertensive inpatients

      Highlights

      • The predictive models for hypertensive patients have several limitations.
      • We estimated a new model in hypertensive inpatients to predict mortality.
      • The model was adapted to a points system to be used in clinical practice.
      • The model has been internally validated using the recommended guidelines.
      • We encourage other authors to externally validate our points system.

      Abstract

      The aim of this study was to construct and internally validate a scoring system to estimate the probability of death in hypertensive inpatients. Existing predictive models do not meet all the indications for clinical application because they were constructed in patients enrolled in clinical trials and did not use the recommended statistical methodology. This cohort study comprised 302 hypertensive patients hospitalized between 2015 and 2017 in Spain. The main variable was time-to-death (all-cause mortality). Secondary variables (potential predictors of the model) were: age, gender, smoking, blood pressure, Charlson Comorbidity Index (CCI), physical activity, diet and quality of life. A Cox model was constructed and adapted to a points system to predict mortality one year from admission. The model was internally validated by bootstrapping, assessing both discrimination and calibration. The system was integrated into a mobile application for Android. During the study, 63 patients died (20.9%). The points system prognostic variables were: gender, CCI, personal care and daily activities. Internal validation showed good discrimination (mean C statistic of 0.76) and calibration (observed probabilities adjusted to predicted probabilities). In conclusion, a points system was developed to determine the one-year mortality risk for hypertensive inpatients. This system is very simple to use and has been internally validated. Clinically, we could monitor more closely those patients with a higher risk of mortality to improve their prognosis and quality of life. However, the system must be externally validated to be applied in other geographic areas.

      Keywords

      Abbreviations:

      DBP (Diastolic blood pressure), CCI (Charlson Comorbidity Index), CI (Confidence interval), EQ5-D (EuroQol five dimensions questionnaire), EPV (Events-per-variable), PREDIMED (Prevention with Mediterranean diet), RAPA (Rapid Assessment of Physical Activity), SBP (Systolic blood pressure)
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