[Reliability of the PROFUND index to predict 4-year mortality in polypathological patients]. / Utilidad del índice PROFUND para predecir la mortalidad a los 4 años en pacientes pluripatológicos.

OBJECTIVE: To determine the usefullness of the PROFUND index to assess the risk of global death after 4 years in polypathological patients. PATIENTS AND METHODS: Multicenter prospective cohort (Internal Medicine and Geriatrics) study. Polypathological patients admitted between March 1st and June 30th 2011 were included. For each patient, data concerning age, sex, living at home or in a nursing residence, polypathology categories, Charlson, Barthel and Lawton-Brody indexes, Pfeiffer questionnaire, socio-familial Gijon scale, delirium, number of drugs, hemoglobin and creatinine values were gathered, and the PROFUND index was calculated. The follow-up lasted 4 years. RESULTS: We included 441 patients, 324 from Internal Medicine and 117 from Geriatrics, with a mean age of 80.9 (8.7) years. Of them, 245 (55.6%) were women. Heart (62.7%), neurological (41.4%) and respiratory (37.3%) diseases were the most frequent. Geriatrics inpatients were older and more dependants and presented greater cognitive deterioration. After 4 years, 335 (76%) patients died. Mortality was associated with age, dyspnoea, Barthel index<60, delirium, advanced neoplasia and≥4 admissions in the last year. The area under the curve of the PROFUND index was 0.748, 95% CI 0.689-0.806, P<.001 in Internal Medicine and 0.517, 95% CI 0.369-0.666, P=.818 in Geriatrics patients, respectively. CONCLUSIONS: The PROFUND index is a reliable tool for predicting long-term global mortality in polypathological patients from Internal Medicine but not from Geriatrics departments.

Differential characteristics in polypathological inpatients in internal medicine departments and acute geriatric units: the PLUPAR study.

AIM: To determine whether there are any differences between polypathological patients attended in Internal Medicine departments and acute Geriatric units. METHODS: A cross-sectional 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 of age, sex, living in a nursing residence or at home, diagnostic category, use of chronic medication, Charlson, Barthel and Lawton-Brody indexes, Pfeiffer questionnaire, delirium during last admission, need of a caregiver, and having a caregiver were gathered. The need of a caregiver was defined when the Barthel index was<60 or Pfeiffer questionnaire ≥ 3 errors. RESULTS: 471 polypathological patients, 337 from internal medicine and 144 from geriatrics units were included. Geriatrics inpatients were older and more frequently female. Cardiac (62.1% vs 49.6%; p=.01), digestive (8.3% vs 3.0%; p=.04) and oncohematological diseases (30.2% vs 18.8%; p=.01) were more frequent in patients of internal medicine units and neurological (66.2% vs 40.2%; p<.001) and locomotive ones (39.1% vs 20.4%; p<.001) in geriatrics inpatients. Charlson index was higher for internal medicine inpatients [4.0(2.1) vs 3.5(2.1); p=.04). Patients attended in geriatrics scored higher in Pfeiffer questionnaire [5.5(3.7) vs 3.8(3.3); p<.001], and lower in Barthel [38.8(32.5) vs 61.2(34.3); p=.001] and Lawton-Brody indexes [0.9(1.6) vs 3.0(2.9); p<.001], and more frequently needed a caregiver (87.8% vs 53.6%; p<.001) and had it. CONCLUSIONS: There are differences in disease profile and functional and cognitive situation between polypathological patients of internal medicine and geriatrics departments.

Utilidad del índice PROFUND para predecir la mortalidad a los 4 años en pacientes pluripatológicos / Reliability of the PROFUND index to predict 4-year mortality in polypathological patients

Objetivo: Determinar la validez del índice PROFUND para establecer el riesgo de muerte global a los 4 años en pacientes pluripatológicos. Pacientes y métodos: Estudio de cohortes (Medicina Interna y Geriatría) prospectivo y multicéntrico. Se incluyeron pacientes pluripatológicos ingresados entre el 1 de marzo y el 30 de junio de 2011. Se recogieron datos de edad, sexo, si vivían en el domicilio o en una residencia, categorías de pluripatología, índices de Charlson, Lawton-Brody y Barthel, cuestionario de Pfeiffer, escala sociofamiliar de Gijón, delirium, número de fármacos, hemoglobina, creatinina e índice PROFUND. Se realizó un seguimiento durante 4 años. Resultados: Se incluyeron 441 pacientes, 324 de Medicina Interna y 117 de Geriatría, con una edad media de 80,9 (8,7) años, y 245 (55,6%) eran mujeres. Las enfermedades cardiacas (62,7%), neurológicas (41,4%) y respiratorias (37,3%) fueron las más frecuentes. Los pacientes de Geriatría eran de más edad, más dependientes y con más deterioro cognitivo. Al cabo de 4 años habían fallecido 335 (76%) pacientes. Los factores asociados de forma independiente con la mortalidad fueron la edad, la disnea, el índice de Barthel<60, el delirium, las neoplasias avanzadas y haber ingresado 4 o más veces en el último año. El rendimiento del índice PROFUND fue bueno en los pacientes de Medicina Interna y malo en los de Geriatría (0,748, IC 95% 0,689-0,806, p<0,001, y 0,517, IC 95% 0,369-0,666, p=0,818, respectivamente). Conclusiones: El índice PROFUND es útil para predecir la mortalidad global a largo plazo en los pacientes pluripatológicos de Medicina Interna, pero no en los de Geriatría (AU)

Objective: To determine the usefullness of the PROFUND index to assess the risk of global death after 4 years in polypathological patients. Patients and methods: Multicenter prospective cohort (Internal Medicine and Geriatrics) study. Polypathological patients admitted between March 1st and June 30th 2011 were included. For each patient, data concerning age, sex, living at home or in a nursing residence, polypathology categories, Charlson, Barthel and Lawton-Brody indexes, Pfeiffer questionnaire, socio-familial Gijon scale,delirium, number of drugs, hemoglobin and creatinine values were gathered, and the PROFUND index was calculated. The follow-up lasted 4 years. Results: We included 441 patients, 324 from Internal Medicine and 117 from Geriatrics, with a mean age of 80.9 (8.7) years. Of them, 245 (55.6%) were women. Heart (62.7%), neurological (41.4%) and respiratory (37.3%) diseases were the most frequent. Geriatrics inpatients were older and more dependants and presented greater cognitive deterioration. After 4 years, 335 (76%) patients died. Mortality was associated with age, dyspnoea, Barthel index<60,delirium, advanced neoplasia and≥4 admissions in the last year. The area under the curve of the PROFUND index was 0.748, 95% CI 0.689-0.806, P<.001 in Internal Medicine and 0.517, 95% CI 0.369-0.666, P=.818 in Geriatrics patients, respectively. Conclusions: The PROFUND index is a reliable tool for predicting long-term global mortality in polypathological patients from Internal Medicine but not from Geriatrics departments (AU)