Advanced

Importance and added value of functional impairment to predict mortality : A cohort study in Swedish medical inpatients

Torisson, Gustav LU ; Stavenow, Lars; Minthon, Lennart LU and Londos, Elisabet LU (2017) In BMJ Open 7(5).
Abstract

Background Accurate estimation of prognosis in multimorbid hospital patients could improve quality of care. This study aims to determine the relative importance and added value of a performance-based activities of daily living (ADL) measure with regard to mortality prediction. Methods 200 inpatients, aged over 60 years, were recruited at the Department of General Internal Medicine at a tertiary university hospital. Two nested survival models were built, one with established risk factors (age, sex, Charlson comorbidity index, haemoglobin, albumin, body mass index and glomerular filtration rate), and one using the same covariates with the Gottfries-Bråne-Steen (GBS)-ADL measure added. The relative importance of GBS-ADL was evaluated in... (More)

Background Accurate estimation of prognosis in multimorbid hospital patients could improve quality of care. This study aims to determine the relative importance and added value of a performance-based activities of daily living (ADL) measure with regard to mortality prediction. Methods 200 inpatients, aged over 60 years, were recruited at the Department of General Internal Medicine at a tertiary university hospital. Two nested survival models were built, one with established risk factors (age, sex, Charlson comorbidity index, haemoglobin, albumin, body mass index and glomerular filtration rate), and one using the same covariates with the Gottfries-Bråne-Steen (GBS)-ADL measure added. The relative importance of GBS-ADL was evaluated in the full model. The added value of GBS-ADL was determined by comparing the nested models using four approaches: difference in overall I ‡ 2, discrimination, continuous net reclassification index (NRI >0) and integrated discrimination improvement (IDI). Results In the full model, GBS-ADL was the single most important predictor of mortality (I ‡ 2-df=30, p<0.001). The likelihood ratio I ‡ 2 test showed significant added value of ADL (p<0.001). The C-statistic was 0.78 with ADL and 0.72 without (difference 0.058, 95% CI 0.022 to 0.094). The NRI >0 was 0.42 (95% CI 0.20 to 0.58) and IDI 0.15 (95% CI 0.07 to 0.22). Conclusions Compared with a set of available clinical risk factors, impairment in ADL was a stronger predictor of all-cause mortality, showing substantial added value. Implementing quantitative ADL measurements could enable more appropriate and individual care for the elderly.

(Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
aging, comorbidity, functional status, mortality, statistical modeling
in
BMJ Open
volume
7
issue
5
publisher
British Medical Journal Publishing Group
external identifiers
  • scopus:85020003496
  • wos:000402533300048
ISSN
2044-6055
DOI
10.1136/bmjopen-2016-014464
language
English
LU publication?
yes
id
daf1d185-543a-46ff-aae5-9da4df0aa5a6
date added to LUP
2017-07-03 16:37:57
date last changed
2017-09-18 11:37:20
@article{daf1d185-543a-46ff-aae5-9da4df0aa5a6,
  abstract     = {<p>Background Accurate estimation of prognosis in multimorbid hospital patients could improve quality of care. This study aims to determine the relative importance and added value of a performance-based activities of daily living (ADL) measure with regard to mortality prediction. Methods 200 inpatients, aged over 60 years, were recruited at the Department of General Internal Medicine at a tertiary university hospital. Two nested survival models were built, one with established risk factors (age, sex, Charlson comorbidity index, haemoglobin, albumin, body mass index and glomerular filtration rate), and one using the same covariates with the Gottfries-Bråne-Steen (GBS)-ADL measure added. The relative importance of GBS-ADL was evaluated in the full model. The added value of GBS-ADL was determined by comparing the nested models using four approaches: difference in overall I ‡ 2, discrimination, continuous net reclassification index (NRI &gt;0) and integrated discrimination improvement (IDI). Results In the full model, GBS-ADL was the single most important predictor of mortality (I ‡ 2-df=30, p&lt;0.001). The likelihood ratio I ‡ 2 test showed significant added value of ADL (p&lt;0.001). The C-statistic was 0.78 with ADL and 0.72 without (difference 0.058, 95% CI 0.022 to 0.094). The NRI &gt;0 was 0.42 (95% CI 0.20 to 0.58) and IDI 0.15 (95% CI 0.07 to 0.22). Conclusions Compared with a set of available clinical risk factors, impairment in ADL was a stronger predictor of all-cause mortality, showing substantial added value. Implementing quantitative ADL measurements could enable more appropriate and individual care for the elderly.</p>},
  articleno    = {e014464},
  author       = {Torisson, Gustav and Stavenow, Lars and Minthon, Lennart and Londos, Elisabet},
  issn         = {2044-6055},
  keyword      = {aging,comorbidity,functional status,mortality,statistical modeling},
  language     = {eng},
  month        = {05},
  number       = {5},
  publisher    = {British Medical Journal Publishing Group},
  series       = {BMJ Open},
  title        = {Importance and added value of functional impairment to predict mortality : A cohort study in Swedish medical inpatients},
  url          = {http://dx.doi.org/10.1136/bmjopen-2016-014464},
  volume       = {7},
  year         = {2017},
}