دورية أكاديمية
أعرض في EDS

Predicting mortality in patients diagnosed with advanced dementia presenting at an acute care hospital: the PROgnostic Model for Advanced DEmentia (PRO-MADE).

التفاصيل البيبلوغرافية
العنوان: Predicting mortality in patients diagnosed with advanced dementia presenting at an acute care hospital: the PROgnostic Model for Advanced DEmentia (PRO-MADE).
المؤلفون: Kaur P; Health Services and Outcomes Research, National Healthcare Group, 3 Fusionopolis Link, #03-08, Singapore, 138543, Singapore., Kannapiran P; Health Services and Outcomes Research, National Healthcare Group, 3 Fusionopolis Link, #03-08, Singapore, 138543, Singapore., Ng SHX; Health Services and Outcomes Research, National Healthcare Group, 3 Fusionopolis Link, #03-08, Singapore, 138543, Singapore., Chu J; Department of Palliative Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore., Low ZJ; Department of Palliative Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore., Ding YY; Geriatric Education and Research Institute, 2 Yishun Central 2, Singapore, 768024, Singapore., Tan WS; Health Services and Outcomes Research, National Healthcare Group, 3 Fusionopolis Link, #03-08, Singapore, 138543, Singapore., Hum A; Palliative Care Centre for Excellence in Research and Education, Tan Tock Seng Hospital, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore. allyn_hum@ttsh.com.sg.
المصدر: BMC geriatrics [BMC Geriatr] 2023 Apr 28; Vol. 23 (1), pp. 255. Date of Electronic Publication: 2023 Apr 28.
نوع المنشور: Journal Article; Research Support, Non-U.S. Gov't
اللغة: English
بيانات الدورية: Publisher: BioMed Central Country of Publication: England NLM ID: 100968548 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2318 (Electronic) Linking ISSN: 14712318 NLM ISO Abbreviation: BMC Geriatr Subsets: MEDLINE
أسماء مطبوعة: Original Publication: London : BioMed Central, [2001]-
مواضيع طبية MeSH: Activities of Daily Living* , Dementia*/diagnosis , Dementia*/epidemiology , Dementia*/therapy, Humans ; Male ; Aged, 80 and over ; Prognosis ; Retrospective Studies ; Hospitals
مستخلص: Background: Challenges in prognosticating patients diagnosed with advanced dementia (AD) hinders timely referrals to palliative care. We aim to develop and validate a prognostic model to predict one-year all-cause mortality (ACM) in patients with AD presenting at an acute care hospital.
Methods: This retrospective cohort study utilised administrative and clinical data from Tan Tock Seng Hospital (TTSH). Patients admitted to TTSH between 1st July 2016 and 31st October 2017 and identified to have AD were included. The primary outcome was ACM within one-year of AD diagnosis. Multivariable logistic regression was used. The PROgnostic Model for Advanced Dementia (PRO-MADE) was internally validated using a bootstrap resampling of 1000 replications and externally validated on a more recent cohort of AD patients. The model was evaluated for overall predictive accuracy (Nagelkerke's R 2 and Brier score), discriminative [area-under-the-curve (AUC)], and calibration [calibration slope and calibration-in-the-large (CITL)] properties.
Results: A total of 1,077 patients with a mean age of 85 (SD: 7.7) years old were included, and 318 (29.5%) patients died within one-year of AD diagnosis. Predictors of one-year ACM were age > 85 years (OR:1.87; 95%CI:1.36 to 2.56), male gender (OR:1.62; 95%CI:1.18 to 2.22), presence of pneumonia (OR:1.75; 95%CI:1.25 to 2.45), pressure ulcers (OR:2.60; 95%CI:1.57 to 4.31), dysphagia (OR:1.53; 95%CI:1.11 to 2.11), Charlson Comorbidity Index ≥ 8 (OR:1.39; 95%CI:1.01 to 1.90), functional dependency in ≥ 4 activities of daily living (OR: 1.82; 95%CI:1.32 to 2.53), abnormal urea (OR:2.16; 95%CI:1.58 to 2.95) and abnormal albumin (OR:3.68; 95%CI:2.07 to 6.54) values. Internal validation results for optimism-adjusted Nagelkerke's R 2 , Brier score, AUC, calibration slope and CITL were 0.25 (95%CI:0.25 to 0.26), 0.17 (95%CI:0.17 to 0.17), 0.76 (95%CI:0.76 to 0.76), 0.95 (95% CI:0.95 to 0.96) and 0 (95%CI:-0.0001 to 0.001) respectively. When externally validated, the model demonstrated an AUC of 0.70 (95%CI:0.69 to 0.71), calibration slope of 0.64 (95%CI:0.63 to 0.66) and CITL of -0.27 (95%CI:-0.28 to -0.26).
Conclusion: The PRO-MADE attained good discrimination and calibration properties. Used synergistically with a clinician's judgement, this model can identify AD patients who are at high-risk of one-year ACM to facilitate timely referrals to palliative care.
(© 2023. The Author(s).)
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فهرسة مساهمة: Keywords: Acute care setting; Advanced dementia; One-year mortality; Palliative care; Prognostication
تواريخ الأحداث: Date Created: 20230428 Date Completed: 20230501 Latest Revision: 20230502
رمز التحديث: 20230502
مُعرف محوري في PubMed: PMC10148534
DOI: 10.1186/s12877-023-03945-8
PMID: 37118683
قاعدة البيانات: MEDLINE
الوصف
تدمد:1471-2318
DOI:10.1186/s12877-023-03945-8