title: Development and validation of the HOPE prognostic index on 24-month posthospital mortality and rehospitalization: Italian National Research Center on Aging (INRCA).
abstract: BACKGROUND
  A fast and simple tool is needed to test for the risk of mortality and rehospitalization in older patients.
  
  
  OBJECTIVE
  The aim of this study was to construct and validate a prognostic index using specific items from the Comprehensive Geriatric Assessment (CGA) in a large population of older hospitalized adults.
  
  
  METHODS
  This was a prospective study of a 24-month follow-up period, between 2005 to 2008 in 3,043 elderly patients (mean age, 81 ± 6) discharged from three acute geriatric wards in the Marche region of Italy. Baseline predictors of demographics and 25 items from the CGA regarding functional and cognitive status, depression, co-morbidity, social isolation, and quality of life were used to build a summary score, the Hospitalized Older Patient Examination (HOPE) Index. The HOPE index was developed in 1,533 patients and validated in 1,510 consecutively hospitalized patients. Outcome measures were 24-month mortality and rehospitalization.
  
  
  RESULTS
  Three risk categories of HOPE based on the best sensitivity and specificity for mortality and rehospitalization were: Low (≤4), moderate (4-8), and high (≥8). Categorizing data across the HOPE index, mortality ranged from 7.9% to 14.5% in the development cohort and 6.2% to 14.0% in the validation cohort, whereas rehospitalization ranged from 68.3% to 79.4% and 69.8% to 79.8%, respectively. Kaplan-Meier survival curves demonstrated that risk for mortality increased with a worsening across the HOPE index (p < 0.001). In the development and validation cohorts, a close agreement was found for HOPE on mortality and rehospitalization with a receiver operating characteristic (ROC) of 0.69 (95% confidence interval [CI] 0.61-0.74) vs. 0.67 (95% CI 0.57-0.70) and rehospitalization of 0.62 (95% CI 0.58-0.66) vs. 0.60 (95% CI 0.56-0.63), respectively. In the development and validation cohorts, Cox proportional hazard models showed that a high HOPE index predicted risks of 2.38 (1.34-4.23) and 2.86 (1.24-6.61) on mortality and 1.27 (1.09-1.44) and 1.37 (1.10-1.64) on rehospitalization, respectively.
  
  
  CONCLUSIONS
  HOPE may be useful for long-term clinical planning, discharge, and follow-up.
authors.affiliation: INRCA (Italian National Research Center on Aging), Ancona 60100, Italy. angela_abbatecola@libero.it
authors.forename: Angela Marie
authors.initials: AM
authors.lastname: Abbatecola
authors.forename: Liana
authors.initials: L
authors.lastname: Spazzafumo
authors.forename: Andrea
authors.initials: A
authors.lastname: Corsonello
authors.forename: Cristina
authors.initials: C
authors.lastname: Sirolla
authors.forename: Silvia
authors.initials: S
authors.lastname: Bustacchini
authors.forename: Enrico
authors.initials: E
authors.lastname: Guffanti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods*; D005853:Geriatrics / Q000379:methods*; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D012306:Risk