Díez-Manglano Jesús, Cabrerizo García José Luis, García-Arilla Calvo Ernesto, Jimeno Saínz Araceli, Calvo Beguería Eva, Martínez-Álvarez Rosa M, Bejarano Tello Esperanza, Caudevilla Martínez Aránzazu
Internal Medicine Department, Hospital Royo Villanova, Avda San Gregorio no 30, 50015, Saragossa, Spain.
Research Group on Comorbidity and Polypathology in Aragón, Aragón Health Sciences Institute, Saragossa, Spain.
Intern Emerg Med. 2015 Dec;10(8):915-26. doi: 10.1007/s11739-015-1252-2. Epub 2015 May 19.
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.
该研究的目的是对外前瞻性地验证PROFUND指数，以预测患有多种疾病的患者一年后的生存率。进行了一项观察性、前瞻性多中心研究。纳入了2011年3月1日至6月30日期间连续由研究人员诊治的内科或老年病科收治的患有多种疾病的患者。收集了每位患者的年龄、性别、合并症、Barthel指数和Lawton-Brody指数、Pfeiffer问卷、社会家庭希洪量表、谵妄、药物数量和上一年的住院次数等数据。计算PROFUND指数。随访持续1年。计算了Cox比例回归模型，并用于分析变量与死亡率和C统计量之间的关联。共纳入465例患有多种疾病的患者，其中333例来自内科，132例来自老年病科。一年死亡率与年龄相关[风险比（HR）1.52，95%可信区间1.04 - 2.12；p = 0.01]、肿瘤的存在[HR 2.68，95%可信区间1.71 - 4.18；p = 0.0001]以及日常生活基本活动的依赖性[HR 2.34，95%可信区间1.61 - 3.40；p = 0.0009]。在预测死亡率方面，PROFUND指数在内科患者中显示出良好的区分度（C统计量0.725，95%可信区间0.670 - 0.781），但在老年病科患者中区分度较差（0.546，95%可信区间0.448 - 0.644）。PROFUND指数是预测内科多种疾病患者死亡率的可靠工具。
