Rius Cristina, Pérez Glòria, Rodríguez-Sanz Maica, Fernàndez Esteve
Public Health Agency of Barcelona, Epidemiology Service, Plaça Lesseps, 1. 08023 Barcelona, Spain.
J Clin Epidemiol. 2008 Aug;61(8):796-802. doi: 10.1016/j.jclinepi.2007.09.006. Epub 2008 Mar 28.
To validate the prognostic accuracy of a previously proposed comorbidity index using information of a different and separate population-based cohort.
We assessed the predictive accuracy of a comorbidity index to predict mortality by looking at calibration and discrimination in the development cohort as well as in a new cohort for validation. Calibration of the model was assessed by comparing predicted and current mortality in the new cohort by means of Hosmer-Lemeshow test (HL). Discrimination of the models was analyzed using the area under the receiver operating characteristic curves (ROC).
In the development cohort, we have not detected differences between the predicted and the observed mortality in both, men (HL=7.7, P=0.46) and women (HL=11.7, P=0.16). The discrimination of the model accounted 81% in men and 79% in women. In the validation cohort, we obtained a good calibration among men (HL=10.1, P=0.43) but not in women (HL=21.4, P=0.01). The discrimination was quite similar to the development cohort in both sexes (ROC area=80% in men, ROC area=78% in women).
The comorbidity index has good calibration and discrimination and was successfully validated in a different population-based cohort among men but not among women.
使用来自不同且独立的基于人群队列的信息，验证先前提出的合并症指数的预后准确性。
我们通过观察开发队列以及用于验证的新队列中的校准和区分度，评估合并症指数预测死亡率的预测准确性。通过 Hosmer-Lemeshow 检验（HL）比较新队列中预测死亡率和当前死亡率，评估模型的校准情况。使用受试者工作特征曲线（ROC）下的面积分析模型的区分度。
在开发队列中，我们在男性（HL = 7.7，P = 0.46）和女性（HL = 11.7，P = 0.16）中均未检测到预测死亡率与观察死亡率之间的差异。该模型的区分度在男性中为 81%，在女性中为 79%。在验证队列中，我们在男性中获得了良好的校准（HL = 10.1，P = 0.43），但在女性中未获得（HL = 21.4，P = 0.01）。两性的区分度与开发队列相当相似（男性的 ROC 面积 = 80%，女性的 ROC 面积 = 78%）。
合并症指数具有良好的校准和区分度，并在不同的基于人群队列中的男性中成功得到验证，但在女性中未得到验证。
