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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 11, 2018
Accepted:
July 8,
2018
Received in revised form:
June 26,
2018
Received:
May 30,
2018
Identification
Copyright
© 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
