Validation of prognostic indices for short term mortality in an incident dialysis population of older adults >75
Prognosis provides critical knowledge for shared decision making between patients and clinicians. While several prognostic indices for mortality in dialysis patients have been developed, their performance among elderly patients initiating dialysis is unknown, despite great need for reliable prognost...
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| creator | Thorsteinsdottir, Bjorg Hickson, LaTonya J Giblon, Rachel Pajouhi, Atieh Connell, Natalie Branda, Megan Vasdev, Amrit K McCoy, Rozalina G Zand, Ladan Tangri, Navdeep Shah, Nilay D |
| description | Prognosis provides critical knowledge for shared decision making between patients and clinicians. While several prognostic indices for mortality in dialysis patients have been developed, their performance among elderly patients initiating dialysis is unknown, despite great need for reliable prognostication in that context. To assess the performance of 6 previously validated prognostic indices to predict 3 and/or 6 months mortality in a cohort of elderly incident dialysis patients.
Validation study of prognostic indices using retrospective cohort data. Indices were compared using the concordance ("c")-statistic, i.e. area under the receiver operating characteristic curve (ROC). Calibration, sensitivity, specificity, positive and negative predictive values were also calculated.
Incident elderly (age ≥75 years; n = 349) dialysis patients at a tertiary referral center.
Variables for six validated prognostic indices for short term (3 and 6 month) mortality prediction (Foley, NCI, REIN, updated REIN, Thamer, and Wick) were extracted from the electronic medical record. The indices were individually applied as per each index specifications to predict 3- and/or 6-month mortality.
In our cohort of 349 patients, mean age was 81.5±4.4 years, 66% were male, and median survival was 351 days. The c-statistic for the risk prediction indices ranged from 0.57 to 0.73. Wick ROC 0.73 (0.68, 0.78) and Foley 0.67 (0.61, 0.73) indices performed best. The Foley index was weakly calibrated with poor overall model fit (p |
| doi_str_mv | 10.1371/journal.pone.0244081 |
| format | Article |
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Validation study of prognostic indices using retrospective cohort data. Indices were compared using the concordance ("c")-statistic, i.e. area under the receiver operating characteristic curve (ROC). Calibration, sensitivity, specificity, positive and negative predictive values were also calculated.
Incident elderly (age ≥75 years; n = 349) dialysis patients at a tertiary referral center.
Variables for six validated prognostic indices for short term (3 and 6 month) mortality prediction (Foley, NCI, REIN, updated REIN, Thamer, and Wick) were extracted from the electronic medical record. The indices were individually applied as per each index specifications to predict 3- and/or 6-month mortality.
In our cohort of 349 patients, mean age was 81.5±4.4 years, 66% were male, and median survival was 351 days. The c-statistic for the risk prediction indices ranged from 0.57 to 0.73. Wick ROC 0.73 (0.68, 0.78) and Foley 0.67 (0.61, 0.73) indices performed best. The Foley index was weakly calibrated with poor overall model fit (p <0.01) and overestimated mortality risk, while the Wick index was relatively well-calibrated but underestimated mortality risk.
Small sample size, use of secondary data, need for imputation, homogeneous population.
Most predictive indices for mortality performed moderately in our incident dialysis population. The Wick and Foley indices were the best performing, but had issues with under and over calibration. More accurate indices for predicting survival in older patients with kidney failure are needed.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0244081</identifier><identifier>PMID: 33471808</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adults ; Aged ; Aged patients ; Aged, 80 and over ; Area Under Curve ; Biology and Life Sciences ; Calibration ; Care and treatment ; Colleges & universities ; Comorbidity ; Data analysis ; Decision making ; Demographic variables ; Demographics ; Demography ; Dialysis ; Editing ; Ethics ; Evaluation ; Female ; Forecasts and trends ; Goodness of fit ; Health care ; Health care delivery ; Health risks ; Hemodialysis ; Humans ; Hypertension ; Independent variables ; Informatics ; Internal medicine ; Kidney Failure, Chronic - mortality ; Kidney Failure, Chronic - pathology ; Laboratories ; Living arrangements ; Male ; Medical prognosis ; Medicine ; Medicine and Health Sciences ; Methodology ; Mortality ; Nephrology ; Older people ; Patient outcomes ; Patients ; Population ; Population studies ; Predictive Value of Tests ; Prognosis ; Public health ; Renal Dialysis ; Retrospective Studies ; Risk Assessment ; ROC Curve ; Social Sciences ; Survival Rate ; Tertiary Care Centers ; Transplants & implants ; Variables</subject><ispartof>PloS one, 2021-01, Vol.16 (1), p.e0244081</ispartof><rights>COPYRIGHT 2021 Public Library of Science</rights><rights>2021 Thorsteinsdottir et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 Thorsteinsdottir et al 2021 Thorsteinsdottir et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-42b13e61efaaa3a7961f559f61ac08809646a417eab4e5adfc8f22a2536385283</citedby><cites>FETCH-LOGICAL-c692t-42b13e61efaaa3a7961f559f61ac08809646a417eab4e5adfc8f22a2536385283</cites><orcidid>0000-0002-4397-728X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816982/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816982/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2101,2927,23865,27923,27924,53790,53792,79471,79472</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33471808$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Bolignano, Davide</contributor><creatorcontrib>Thorsteinsdottir, Bjorg</creatorcontrib><creatorcontrib>Hickson, LaTonya J</creatorcontrib><creatorcontrib>Giblon, Rachel</creatorcontrib><creatorcontrib>Pajouhi, Atieh</creatorcontrib><creatorcontrib>Connell, Natalie</creatorcontrib><creatorcontrib>Branda, Megan</creatorcontrib><creatorcontrib>Vasdev, Amrit K</creatorcontrib><creatorcontrib>McCoy, Rozalina G</creatorcontrib><creatorcontrib>Zand, Ladan</creatorcontrib><creatorcontrib>Tangri, Navdeep</creatorcontrib><creatorcontrib>Shah, Nilay D</creatorcontrib><title>Validation of prognostic indices for short term mortality in an incident dialysis population of older adults >75</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Prognosis provides critical knowledge for shared decision making between patients and clinicians. While several prognostic indices for mortality in dialysis patients have been developed, their performance among elderly patients initiating dialysis is unknown, despite great need for reliable prognostication in that context. To assess the performance of 6 previously validated prognostic indices to predict 3 and/or 6 months mortality in a cohort of elderly incident dialysis patients.
Validation study of prognostic indices using retrospective cohort data. Indices were compared using the concordance ("c")-statistic, i.e. area under the receiver operating characteristic curve (ROC). Calibration, sensitivity, specificity, positive and negative predictive values were also calculated.
Incident elderly (age ≥75 years; n = 349) dialysis patients at a tertiary referral center.
Variables for six validated prognostic indices for short term (3 and 6 month) mortality prediction (Foley, NCI, REIN, updated REIN, Thamer, and Wick) were extracted from the electronic medical record. The indices were individually applied as per each index specifications to predict 3- and/or 6-month mortality.
In our cohort of 349 patients, mean age was 81.5±4.4 years, 66% were male, and median survival was 351 days. The c-statistic for the risk prediction indices ranged from 0.57 to 0.73. Wick ROC 0.73 (0.68, 0.78) and Foley 0.67 (0.61, 0.73) indices performed best. The Foley index was weakly calibrated with poor overall model fit (p <0.01) and overestimated mortality risk, while the Wick index was relatively well-calibrated but underestimated mortality risk.
Small sample size, use of secondary data, need for imputation, homogeneous population.
Most predictive indices for mortality performed moderately in our incident dialysis population. The Wick and Foley indices were the best performing, but had issues with under and over calibration. More accurate indices for predicting survival in older patients with kidney failure are needed.</description><subject>Adults</subject><subject>Aged</subject><subject>Aged patients</subject><subject>Aged, 80 and over</subject><subject>Area Under Curve</subject><subject>Biology and Life Sciences</subject><subject>Calibration</subject><subject>Care and treatment</subject><subject>Colleges & universities</subject><subject>Comorbidity</subject><subject>Data analysis</subject><subject>Decision making</subject><subject>Demographic variables</subject><subject>Demographics</subject><subject>Demography</subject><subject>Dialysis</subject><subject>Editing</subject><subject>Ethics</subject><subject>Evaluation</subject><subject>Female</subject><subject>Forecasts and trends</subject><subject>Goodness of fit</subject><subject>Health care</subject><subject>Health care delivery</subject><subject>Health risks</subject><subject>Hemodialysis</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Independent variables</subject><subject>Informatics</subject><subject>Internal medicine</subject><subject>Kidney Failure, Chronic - mortality</subject><subject>Kidney Failure, Chronic - pathology</subject><subject>Laboratories</subject><subject>Living arrangements</subject><subject>Male</subject><subject>Medical prognosis</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Methodology</subject><subject>Mortality</subject><subject>Nephrology</subject><subject>Older people</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Population</subject><subject>Population studies</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Public health</subject><subject>Renal Dialysis</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>ROC Curve</subject><subject>Social Sciences</subject><subject>Survival Rate</subject><subject>Tertiary Care Centers</subject><subject>Transplants & 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of prognostic indices for short term mortality in an incident dialysis population of older adults >75</title><author>Thorsteinsdottir, Bjorg ; Hickson, LaTonya J ; Giblon, Rachel ; Pajouhi, Atieh ; Connell, Natalie ; Branda, Megan ; Vasdev, Amrit K ; McCoy, Rozalina G ; Zand, Ladan ; Tangri, Navdeep ; Shah, Nilay D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-42b13e61efaaa3a7961f559f61ac08809646a417eab4e5adfc8f22a2536385283</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adults</topic><topic>Aged</topic><topic>Aged patients</topic><topic>Aged, 80 and over</topic><topic>Area Under Curve</topic><topic>Biology and Life Sciences</topic><topic>Calibration</topic><topic>Care and treatment</topic><topic>Colleges & universities</topic><topic>Comorbidity</topic><topic>Data analysis</topic><topic>Decision making</topic><topic>Demographic variables</topic><topic>Demographics</topic><topic>Demography</topic><topic>Dialysis</topic><topic>Editing</topic><topic>Ethics</topic><topic>Evaluation</topic><topic>Female</topic><topic>Forecasts and trends</topic><topic>Goodness of fit</topic><topic>Health care</topic><topic>Health care delivery</topic><topic>Health risks</topic><topic>Hemodialysis</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Independent variables</topic><topic>Informatics</topic><topic>Internal medicine</topic><topic>Kidney Failure, Chronic - mortality</topic><topic>Kidney Failure, Chronic - pathology</topic><topic>Laboratories</topic><topic>Living arrangements</topic><topic>Male</topic><topic>Medical prognosis</topic><topic>Medicine</topic><topic>Medicine and Health Sciences</topic><topic>Methodology</topic><topic>Mortality</topic><topic>Nephrology</topic><topic>Older people</topic><topic>Patient outcomes</topic><topic>Patients</topic><topic>Population</topic><topic>Population studies</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Public health</topic><topic>Renal Dialysis</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>ROC Curve</topic><topic>Social Sciences</topic><topic>Survival Rate</topic><topic>Tertiary Care Centers</topic><topic>Transplants & implants</topic><topic>Variables</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Thorsteinsdottir, Bjorg</creatorcontrib><creatorcontrib>Hickson, LaTonya J</creatorcontrib><creatorcontrib>Giblon, Rachel</creatorcontrib><creatorcontrib>Pajouhi, Atieh</creatorcontrib><creatorcontrib>Connell, Natalie</creatorcontrib><creatorcontrib>Branda, Megan</creatorcontrib><creatorcontrib>Vasdev, Amrit K</creatorcontrib><creatorcontrib>McCoy, Rozalina G</creatorcontrib><creatorcontrib>Zand, Ladan</creatorcontrib><creatorcontrib>Tangri, Navdeep</creatorcontrib><creatorcontrib>Shah, Nilay 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D</au><au>Bolignano, Davide</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Validation of prognostic indices for short term mortality in an incident dialysis population of older adults >75</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2021-01-20</date><risdate>2021</risdate><volume>16</volume><issue>1</issue><spage>e0244081</spage><pages>e0244081-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Prognosis provides critical knowledge for shared decision making between patients and clinicians. While several prognostic indices for mortality in dialysis patients have been developed, their performance among elderly patients initiating dialysis is unknown, despite great need for reliable prognostication in that context. To assess the performance of 6 previously validated prognostic indices to predict 3 and/or 6 months mortality in a cohort of elderly incident dialysis patients.
Validation study of prognostic indices using retrospective cohort data. Indices were compared using the concordance ("c")-statistic, i.e. area under the receiver operating characteristic curve (ROC). Calibration, sensitivity, specificity, positive and negative predictive values were also calculated.
Incident elderly (age ≥75 years; n = 349) dialysis patients at a tertiary referral center.
Variables for six validated prognostic indices for short term (3 and 6 month) mortality prediction (Foley, NCI, REIN, updated REIN, Thamer, and Wick) were extracted from the electronic medical record. The indices were individually applied as per each index specifications to predict 3- and/or 6-month mortality.
In our cohort of 349 patients, mean age was 81.5±4.4 years, 66% were male, and median survival was 351 days. The c-statistic for the risk prediction indices ranged from 0.57 to 0.73. Wick ROC 0.73 (0.68, 0.78) and Foley 0.67 (0.61, 0.73) indices performed best. The Foley index was weakly calibrated with poor overall model fit (p <0.01) and overestimated mortality risk, while the Wick index was relatively well-calibrated but underestimated mortality risk.
Small sample size, use of secondary data, need for imputation, homogeneous population.
Most predictive indices for mortality performed moderately in our incident dialysis population. The Wick and Foley indices were the best performing, but had issues with under and over calibration. More accurate indices for predicting survival in older patients with kidney failure are needed.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>33471808</pmid><doi>10.1371/journal.pone.0244081</doi><tpages>e0244081</tpages><orcidid>https://orcid.org/0000-0002-4397-728X</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2021-01, Vol.16 (1), p.e0244081 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2479451649 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS); EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adults Aged Aged patients Aged, 80 and over Area Under Curve Biology and Life Sciences Calibration Care and treatment Colleges & universities Comorbidity Data analysis Decision making Demographic variables Demographics Demography Dialysis Editing Ethics Evaluation Female Forecasts and trends Goodness of fit Health care Health care delivery Health risks Hemodialysis Humans Hypertension Independent variables Informatics Internal medicine Kidney Failure, Chronic - mortality Kidney Failure, Chronic - pathology Laboratories Living arrangements Male Medical prognosis Medicine Medicine and Health Sciences Methodology Mortality Nephrology Older people Patient outcomes Patients Population Population studies Predictive Value of Tests Prognosis Public health Renal Dialysis Retrospective Studies Risk Assessment ROC Curve Social Sciences Survival Rate Tertiary Care Centers Transplants & implants Variables |
| title | Validation of prognostic indices for short term mortality in an incident dialysis population of older adults >75 |
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