External validation of the PROFUND index in polypathological patients from internal medicine and acute geriatrics departments in Aragón

Abstract

The objective of the study was to validate externally and prospectively the PROFUND index to predict survival of polypathological patients after a year. An observational, prospective and multicenter study was performed. Polypathological patients admitted to an internal medicine or geriatrics department and attended by investigators consecutively between March 1 and June 30, 2011 were included. Data concerning age, gender, comorbidity, Barthel and Lawton-Brody indexes, Pfeiffer questionnaire, socio-familial Gijon scale, delirium, number of drugs and number of admissions during the previous year were gathered for each patient. The PROFUND index was calculated. The follow-up lasted 1 year. A Cox proportional regression model was calculated, and was used to analyze the association of the variables to mortality and C-statistic. 465 polypathological patients, 333 from internal medicine and 132 from geriatrics, were included. One-year mortality is associated with age [hazard ratio (HR) 1.52 95 % CI 1.04-2.12; p = 0.01], presence of neoplasia [HR 2.68 95 % CI 1.71-4.18; p = 0.0001] and dependence for basic activities of daily living [HR 2.34 95 % CI 1.61-3.40; p = 0.0009]. In predicting mortality, the PROFUND index shows good discrimination in patients from internal medicine (C-statistics 0.725 95 % CI 0.670-0.781), but a poor one in those from geriatrics (0.546 95 % CI 0.448-0.644). The PROFUND index is a reliable tool for predicting mortality in internal medicine PP patients.

Reliability of three questions for the screening of advanced cognitive impairment in polypathological patients

“…[4][5][6][7][8][9] These conditions cause patients to suffer physical and mental fatigability, and prevent them from sustaining their attention for a long period of time. [4][5][6][7][8][9] These conditions cause patients to suffer physical and mental fatigability, and prevent them from sustaining their attention for a long period of time.…”

“…8,9 Therefore, there is the need not only for a prognostic stratification but also for a therapeutic stratification in PP, in order to provide for each patient the care best adapted to his or her condition and life expectancy. 8,9 Therefore, there is the need not only for a prognostic stratification but also for a therapeutic stratification in PP, in order to provide for each patient the care best adapted to his or her condition and life expectancy.…”

“…Previous studies have reported that 39-50% of PP have cognitive impairment, 44% of them severe dyspnea, and 49% anemia with hemoglobin values <10 mg/dL. [4][5][6][7][8][9] These conditions cause patients to suffer physical and mental fatigability, and prevent them from sustaining their attention for a long period of time. Furthermore, previous comorbidity, the acute disease causing their hospitalization and other factors contributing to the onset of delirium make it difficult to carry out a complete cognitive examination of these patients.…”

“…4,8 It was an observational, prospective and multicenter study in which doctors from the internal medicine and acute geriatrics units of 13 hospitals in Aragon took part (Appendix). The Polypathological Patients in Aragon study has been previously described.…”

“…The Polypathological Patients in Aragon study has been previously described. 4,8 It was an observational, prospective and multicenter study in which doctors from the internal medicine and acute geriatrics units of 13 hospitals in Aragon took part (Appendix). Its main objective was to validate externally the PROFUND index and to describe the clinical characteristics of PP in Aragon.…”