title: Development of a new predictive model for polypathological patients. The PROFUND index.
abstract: BACKGROUND
  There is a concern about the accuracy of the available prognostic indexes when applying them to the emergent population of polypathological patients (PP).
  
  
  METHODS
  To develop a 1-year mortality predictive index on PP, we developed a multicenter prospective cohort-study recruiting 1.632 PP after hospital discharge, outpatient clinics, or home hospitalization, from 33 hospitals. Potential risk factors were obtained in the 1.525 PP who completed follow-up. Each factor independently associated with mortality in the derivation cohort (757 PP from western hospitals) was assigned a weight, and risk scores were calculated by adding the points of each factor. Accuracy was assessed in the validation cohort (768 PP from eastern hospitals) by risk quartiles calibration, and discrimination power, by ROC curves. Finally, accuracy of the index was compared with that of the Charlson index.
  
  
  RESULTS
  Mortality in the derivation/validation cohorts was 35%/39.5%, respectively. Nine independent mortality predictors were identified to create the index (age ≥85 years, 3 points; No caregiver or caregiver other than spouse, 2 points; active neoplasia, 6 points; dementia, 3 points; III-IV functional class on NYHA and/or MRC, 3 points; delirium during last hospital admission, 3 points; hemoglobinemia <10 g/dl, 3 points; Barthel index <60 points, 4 points; ≥4 hospital admissions in last 12 months, 3 points). Mortality in the derivation/validation cohorts was 12.1%/14.6% for patients with 0-2 points; 21.5%/31.5% for those with 3-6 points; 45%/50% for those with 7-10 points; and 68%/61.3% for those with ≥11 points, respectively. Calibration was good in derivation/validation cohorts, and discrimination power by area under the curve was 0.77/0.7. Calibration of the Charlson index was good, but discrimination power was suboptimal (area under the curve, 0.59).
  
  
  CONCLUSIONS
  This prognostic index provides an accurate and transportable method of stratifying 1-year death risk in PP.
authors.affiliation: Internal Medicine Department. Hospital Universitario Virgen del Rocío. Avda Manuel Siurot, s/n. 41013 Sevilla, Spain. maxbw@telefonica.net
authors.forename: M
authors.initials: M
authors.lastname: Bernabeu-Wittel
authors.forename: M
authors.initials: M
authors.lastname: Ollero-Baturone
authors.forename: L
authors.initials: L
authors.lastname: Moreno-Gaviño
authors.forename: B
authors.initials: B
authors.lastname: Barón-Franco
authors.forename: A
authors.initials: A
authors.lastname: Fuertes
authors.forename: J
authors.initials: J
authors.lastname: Murcia-Zaragoza
authors.forename: C
authors.initials: C
authors.lastname: Ramos-Cantos
authors.forename: A
authors.initials: A
authors.lastname: Alemán
authors.forename: A
authors.initials: A
authors.lastname: Fernández-Moyano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000401:mortality*; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D015233:Models, Statistical; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors