title: Validation of PROFUND prognostic index over a four-year follow-up period.
abstract: OBJECTIVE
  The PROFUND index stratifies accurately the 12-month mortality risk of polypathological patients (PPs), but its fitness over a longer follow-up period remains unknown. We aimed to explore the calibration and discrimination power of PROFUND index over 4-years, in order to assess its follow-up interval generalizability.
  
  
  METHODS
  Multicenter prospective cohort-study.
  
  
  METHODS
  33 Spanish hospitals.
  
  
  METHODS
  PPs included after hospital discharge, outpatient clinics, or home hospitalization.
  
  
  METHODS
  Mortality over a 4-year follow-up period.
  
  
  METHODS
  PROFUND index calibration was assessed by risk-quartiles predicted/observed mortality (Hosmer-Lemeshow goodness-of-fit test), and its discrimination power by ROC curves.
  
  
  RESULTS
  A total of 768 patients were included (630 [82%] of them completed the 4-year follow-up). Global mortality rate was 63.5%. When assessing individual patient scores, mortality was 52% in the lowest risk group (0-2 points in PROFUND score); 73.5% in the low-intermediate risk group (3-6 points), 85% in the intermediate-high group (7-10 points); and 92% in the highest risk group (≥11 points). Accuracy testing of the PROFUND index showed good calibration (P=.8 in the Hosmer-Lemeshow goodness-of-fit test), and also a good discrimination power (AUC=0.71 [0.67-0.77] in ROC curve).
  
  
  CONCLUSIONS
  The PROFUND index maintained its accuracy in predicting mortality of polypathological patients over a 4-year follow-up period. This index may be of potential usefulness in deciding the most appropriate health-care interventions in populations with multimorbidity.
authors: Internal Medicine Department of, Hospital Virgen del Rocío, Sevilla, Spain. Electronic address: wittel@cica.es.
authors: M
authors: M
authors: Bernabeu-Wittel
authors: Internal Medicine Department of, Hospital Virgen del Rocío, Sevilla, Spain.
authors: L
authors: L
authors: Moreno-Gaviño
authors: Internal Medicine Department of, Hospital Virgen del Rocío, Sevilla, Spain.
authors: M
authors: M
authors: Ollero-Baturone
authors: Internal Medicine Department of, Hospital Juan Ramón Jiménez, Huelva, Spain.
authors: B
authors: B
authors: Barón-Franco
authors: Internal Medicine Department of, Hospital Royo Villanova, Zaragoza, Spain.
authors: J
authors: J
authors: Díez-Manglano
authors: Internal Medicine Department of, Hospital Virgen del Rocío, Sevilla, Spain.
authors: C
authors: C
authors: Rivas-Cobas
authors: Internal Medicine Department of, Hospital General de Alicante, Spain.
authors: J
authors: J
authors: Murcia-Zaragoza
authors: Internal Medicine Department of, Hospital de la Axarquía, Málaga, Spain.
authors: C
authors: C
authors: Ramos-Cantos
authors: Internal Medicine Department of, Hospital San Juan de Dios del Aljarafe, Sevilla, Spain.
authors: A
authors: A
authors: Fernández-Moyano
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D015331:Cohort Studies; D003693:Delirium / Q000453:epidemiology*; D003704:Dementia / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009026:Mortality; D000071069:Multiple Chronic Conditions / Q000401:mortality*; D009369:Neoplasms / Q000453:epidemiology*; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D018570:Risk Assessment; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology
keywords: Mortality; Multimorbidity; PROFUND; Polypathology; Prognostic index