Comorbidity and prognostic indices do not improve the 5-year mortality prediction of components of comprehensive geriatric assessment in hospitalized older patients

BMC Geriatrics

Berta Ibáñez-Beroiz²  Koldo Cambra-Contin²  Nicolás Martínez-Velilla¹ 

[1] Geriatric Department, Complejo Hospitalario de Navarra, Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Irunlarrea 4, Pamplona 31008, Spain;Navarrabiomed-Fundación Miguel Servet, Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Pamplona, Spain

关键词: Comprehensive geriatric assessment;    Multimorbidity;    Comorbidity scores;    Aged;    5-year mortality;   

Others  :  855051
DOI  :  10.1186/1471-2318-14-64

 received in 2013-12-23, accepted in 2014-04-25,  发布年份 2014

【 摘 要 】

Background

Advancing age is associated with increased vulnerability to chronic health problems. Identifying factors that predict oldest-old status is vital for developing effective clinical interventions and public health strategies.

Methods

Observational prospective study of patients aged 75 years and older consecutively admitted to an Acute Geriatric Ward of a tertiary hospital. After a comprehensive geriatric assessment all patients were assessed for five comorbidity indices and two prognostic models. Univariate and multivariate logistic regression models were fitted to assess the association between each score and 5-year mortality. The ability of each score to predict mortality was assessed using the area under the receiver operating characteristic curve.

Results

122 patients were enrolled. All patients were followed up for five years. 90 (74%) of them died during the study period. In the logistic regression analyses, apart from age, cognitive impairment and Barthel Index, three indices were identified as statistically associated with 5-year mortality: the Geriatric Index of Comorbidity and the two prognostic indices. The multivariate model that combined age, sex, cognitive impairment and Barthel showed a good discriminate ability (AUC = 0.79), and it did not improve substantially after adding individually any of the indices.

Conclusions

Some prognostic models and the Geriatric Index of Comorbidity are better than other widely used indices such as the Charlson Index in predicting 5-year mortality in hospitalized older patients, however, none of these indices is superior to some components of comprehensive geriatric assessment.

【 授权许可】

   
2014 Martínez-Velilla et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]de Groot V, Beckerman H, Lankhorst GJ, Bouter LM: How to measure comorbidity. a critical review of available methods. J Clin Epidemiol 2003, 56:221-229.
• [2]Fortin M, Stewart M, Poitras ME, Almirall J, Maddocks H: A systematic review of prevalence studies on multimorbidity: toward a more uniform methodology. Ann Fam Med 2012, 10:142-151.
• [3]van den Akker MBF, Knottnerus JA: Comorbidity or multimorbidity: what's in a name? A review of literature. Eur J Gen Pract 1996, 2:65-70.
• [4]Martinez Velilla NI, Gaminde Inda ID: [Comorbidity and multimorbidity indexes in the elderly patients]. Med Clin (Barc) 2011, 136:441-446.
• [5]Charlson ME, Pompei P, Ales KL, MacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987, 40:373-383.
• [6]Min L, Wenger N, Walling AM, Blaum C, Cigolle C, Ganz DA, Reuben D, Shekelle P, Roth C, Kerr EA: When comorbidity, aging, and complexity of primary care meet: development and validation of the Geriatric CompleXity of Care Index. J Am Geriatr Soc 2013, 61:542-550.
• [7]Diederichs C, Berger K, Bartels DB: The measurement of multiple chronic diseases–a systematic review on existing multimorbidity indices. J Gerontol A Biol Sci Med Sci 2011, 66:301-311.
• [8]Hall SF: A user's guide to selecting a comorbidity index for clinical research. J Clin Epidemiol 2006, 59:849-855.
• [9]Harboun M, Ankri J: [Comorbidity indexes: review of the literature and application to studies of elderly population]. Rev Epidemiol Sante Publique 2001, 49:287-298.
• [10]Martinez-Velilla N, Ibanez-Beroiz B, Cambra-Contin K, Alonso-Renedo J: Is comprehensive geriatric assessment a better 1-year mortality predictor than comorbidity and prognostic indices in hospitalized older adults? J Am Geriatr Soc 2013, 61:1821-1823.
• [11]Mahoney FI, Barthel DW: Functional evaluation: the barthel index. Md State Med J 1965, 14:61-65.
• [12]Lobo AEJ, Gómez FB, Sala JM, Seva A: El Mini Examen cognoscitivo. Un test sencillo y práctico para detectar alteraciones intelectuales en pacientes médicos. Actas Luso-Esp Neurol Psiquiatr 1979, 7:189-202.
• [13]Inouye SK, Bogardus ST Jr, Vitagliano G, Desai MM, Williams CS, Grady JN, Scinto JD: Burden of illness score for elderly persons: risk adjustment incorporating the cumulative impact of diseases, physiologic abnormalities, and functional impairments. Med Care 2003, 41:70-83.
• [14]Walter LC, Brand RJ, Counsell SR, Palmer RM, Landefeld CS, Fortinsky RH, Covinsky KE: Development and validation of a prognostic index for 1-year mortality in older adults after hospitalization. JAMA 2001, 285:2987-2994.
• [15]Greenfield S, Sullivan L, Dukes KA, Silliman R, D'Agostino R, Kaplan SH: Development and testing of a new measure of case mix for use in office practice. Med Care 1995, 33:AS47-AS55.
• [16]Melfi C, Holleman E, Arthur D, Katz B: Selecting a patient characteristics index for the prediction of medical outcomes using administrative claims data. J Clin Epidemiol 1995, 48:917-926.
• [17]Satariano WA, Ragland DR: The effect of comorbidity on 3-year survival of women with primary breast cancer. Ann Intern Med 1994, 120:104-110.
• [18]Linn BS, Linn MW, Gurel L: Cumulative illness rating scale. J Am Geriatr Soc 1968, 16:622-626.
• [19]Salvi F, Miller MD, Grilli A, Giorgi R, Towers AL, Morichi V, Spazzafumo L, Mancinelli L, Espinosa E, Rappelli A, Dessi-Fulgheri P: A manual of guidelines to score the modified cumulative illness rating scale and its validation in acute hospitalized elderly patients. J Am Geriatr Soc 2008, 56:1926-1931.
• [20]Rozzini R, Frisoni GB, Ferrucci L, Barbisoni P, Sabatini T, Ranieri P, Guralnik JM, Trabucchi M: Geriatric index of comorbidity: validation and comparison with other measures of comorbidity. Age Ageing 2002, 31:277-285.
• [21]Zekry D, Loures Valle BH, Graf C, Michel JP, Gold G, Krause KH, Herrmann FR: Prospective comparison of 6 comorbidity indices as predictors of 1-year post-hospital discharge institutionalization, readmission, and mortality in elderly individuals. J Am Med Dir Assoc 2012, 13:272-278.
• [22]Zekry D, Loures Valle BH, Lardi C, Graf C, Michel JP, Gold G, Krause KH, Herrmann FR: Geriatrics index of comorbidity was the most accurate predictor of death in geriatric hospital among six comorbidity scores. J Clin Epidemiol 2010, 63:1036-1044.
• [23]Zekry D, Valle BH, Michel JP, Esposito F, Gold G, Krause KH, Herrmann FR: Prospective comparison of six co-morbidity indices as predictors of 5 years post hospital discharge survival in the elderly. Rejuvenation Res 2010, 13:675-682.
• [24]Torres Moreno B, Nunez Gonzalez E, Perez Hernandez Dde G, Simon Turriate JP, Alastuey Gimenez C, Diaz Melian J, Corujo Rodriguez E, Gonzalez Bermudez MD, Fernandez Duque O: [Barthel and Charlson indexes for the prognosis of mortality and institutionalization in hospitalized geriatric patients]. Rev Esp Geriatr Gerontol 2009, 44:209-212.
• [25]Testa G, Cacciatore F, Galizia G, Della-Morte D, Mazzella F, Russo S, Ferrara N, Rengo F, Abete P: Charlson comorbidity index does not predict long-term mortality in elderly subjects with chronic heart failure. Age Ageing 2009, 38:734-740.
• [26]Di Bari M, Virgillo A, Matteuzzi D, Inzitari M, Mazzaglia G, Pozzi C, Geppetti P, Masotti G, Marchionni N, Pini R: Predictive validity of measures of comorbidity in older community dwellers: The Insufficienza Cardiaca negli Anziani Residenti a Dicomano Study. J Am Geriatr Soc 2006, 54:210-216.
• [27]van Walraven C, Dhalla IA, Bell C, Etchells E, Stiell IG, Zarnke K, Austin PC, Forster AJ: Derivation and validation of an index to predict early death or unplanned readmission after discharge from hospital to the community. CMAJ 2010, 182:551-557.
• [28]Antman EM, Cohen M, Bernink PJ, McCabe CH, Horacek T, Papuchis G, Mautner B, Corbalan R, Radley D, Braunwald E: The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA 2000, 284:835-842.
• [29]Rietbrock S, Heeley E, Plumb J, van Staa T: Chronic atrial fibrillation: Incidence, prevalence, and prediction of stroke using the Congestive heart failure, Hypertension, Age >75, Diabetes mellitus, and prior Stroke or transient ischemic attack (CHADS2) risk stratification scheme. Am Heart J 2008, 156:57-64.
• [30]D'Agostino RB Sr, Grundy S, Sullivan LM, Wilson P: Validation of the Framingham coronary heart disease prediction scores: results of a multiple ethnic groups investigation. JAMA 2001, 286:180-187.
• [31]Chen L-K, Peng L-N, Lin M-H, Lai H-Y, Hwang S-J, Lan C-F: Predicting mortality of older residents in long-term care facilities: comorbidity or care problems? J Am Med Dir Assoc 2010, 11:567-571.
• [32]Taekema DG, Gussekloo J, Westendorp RGJ, de Craen AJM, Maier AB: Predicting survival in oldest old people. Am J Med 2012, 125:1188-1194. e1181
• [33]Rockwood K, Howlett S, Stadnyk K, Carver D, Powell C, Stolee P: Responsiveness of goal attainment scaling in a randomized controlled trial of comprehensive geriatric assessment. J Clin Epidemiol 2003, 56:736-743.
• [34]Landi F, Onder G, Russo A, Tabaccanti S, Rollo R, Federici S, Tua E, Cesari M, Bernabei R: A new model of integrated home care for the elderly: impact on hospital use. J Clin Epidemiol 2001, 54:968-970.
• [35]Landi F, Liperoti R, Russo A, Capoluongo E, Barillaro C, Pahor M, Bernabei R, Onder G: Disability, more than multimorbidity, was predictive of mortality among older persons aged 80 years and older. In J Clin Epidemiol. Volume 63. United States: Elsevier Inc; 2010::752-759.
• [36]Fried LP, Bandeen-Roche K, Kasper JD, Guralnik JM: Association of comorbidity with disability in older women: the Women's Health and aging study. J Clin Epidemiol 1999, 52:27-37.
• [37]Inouye SK, Peduzzi PN, Robison JT, Hughes JS, Horwitz RI, Concato J: Importance of functional measures in predicting mortality among older hospitalized patients. JAMA 1998, 279:1187-1193.
• [38]Incalzi RA, Capparella O, Gemma A, Landi F, Bruno E, Di Meo F, Carbonin P: The interaction between age and comorbidity contributes to predicting the mortality of geriatric patients in the acute-care hospital. J Intern Med 1997, 242:291-298.
• [39]Rozzini R, Sabatini T, Barbisoni P, Trabucchi M: How to measure comorbidity in elderly persons. J Clin Epidemiol 2004, 57:321-322. author reply 323