Emergency Department, General University Hospital of Elda, Elda, Alicante, Spain.
Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Alicante, Spain.
Eur J Intern Med. 2019 Jan;59:77-83. doi: 10.1016/j.ejim.2018.07.010. Epub 2018 Jul 13.
The aim of this study was to construct and internally validate a scoring system to estimate the probability of death in hypertensive inpatients. Existing predictive models do not meet all the indications for clinical application because they were constructed in patients enrolled in clinical trials and did not use the recommended statistical methodology. This cohort study comprised 302 hypertensive patients hospitalized between 2015 and 2017 in Spain. The main variable was time-to-death (all-cause mortality). Secondary variables (potential predictors of the model) were: age, gender, smoking, blood pressure, Charlson Comorbidity Index (CCI), physical activity, diet and quality of life. A Cox model was constructed and adapted to a points system to predict mortality one year from admission. The model was internally validated by bootstrapping, assessing both discrimination and calibration. The system was integrated into a mobile application for Android. During the study, 63 patients died (20.9%). The points system prognostic variables were: gender, CCI, personal care and daily activities. Internal validation showed good discrimination (mean C statistic of 0.76) and calibration (observed probabilities adjusted to predicted probabilities). In conclusion, a points system was developed to determine the one-year mortality risk for hypertensive inpatients. This system is very simple to use and has been internally validated. Clinically, we could monitor more closely those patients with a higher risk of mortality to improve their prognosis and quality of life. However, the system must be externally validated to be applied in other geographic areas.
本研究旨在构建并内部验证一个评分系统，以估计高血压住院患者的死亡概率。现有的预测模型并不能满足所有临床应用的要求，因为它们是在临床试验中招募的患者中构建的，并且没有使用推荐的统计方法。这项队列研究包括 2015 年至 2017 年期间在西班牙住院的 302 名高血压患者。主要变量是死亡时间（全因死亡率）。次要变量（模型的潜在预测因子）为：年龄、性别、吸烟、血压、Charlson 合并症指数（CCI）、体力活动、饮食和生活质量。构建了 Cox 模型并适应了一个点系统，以预测入院后一年的死亡率。通过自举法对模型进行内部验证，评估了区分度和校准度。该系统已集成到用于 Android 的移动应用程序中。在研究期间，有 63 名患者死亡（20.9%）。点系统预后变量为：性别、CCI、个人护理和日常活动。内部验证显示出良好的区分度（平均 C 统计量为 0.76）和校准度（观察到的概率与预测概率相匹配）。总之，开发了一个点系统来确定高血压住院患者的一年死亡率风险。该系统使用非常简单，并已进行内部验证。从临床角度来看，我们可以更密切地监测那些死亡风险较高的患者，以改善他们的预后和生活质量。然而，该系统必须经过外部验证才能在其他地理区域应用。
