Validation of a model to predict six-month mortality in incident elderly dialysis patients
Autor(a) principal: | |
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Data de Publicação: | 2020 |
Outros Autores: | , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692020000300001 |
Resumo: | Background and objectives: To evaluate RRT benefits and risks and to inform patients and their families about ESRD treatment options, we have developed a prognostic score to predict 6-month mortality in elderly ESRD patients initiating dialysis. Five independent predictors were identified and a point system was constructed: age 75 years or older (2 points), coronary artery disease (2 points), cerebrovascular disease with hemiplegia (2 points), time of nephrology care before dialysis [< 3.0 months (2 points); ≥ 3 to < 12 months (1 point)], serum albumin levels [3.0 - 3.49 g/dL (1 point); < 3.0 g/dL (2 points)]. Model performance was good in both discrimination and internal validation. Before adopting our risk score into practice, our aim is to externally validate this initial predictive model by assessing its performance on a new data set. Methods: We apply the predictive score developed in a cohort of CKD patients, aged 65 years and over who started dialysis between 2009 and 2016, to an independent cohort of ESRD patients, aged 65 years and over who started dialysis between 2017 and 2019, in our Nephrology department. The performance of the prediction equation created in development cohort, was assessed using discrimination and calibration metrics in the validation cohort. Results: Our validation study cohort included 168 individuals, with a mortality rate of 12.5% (n=21) within 6-months of dialysis initiation. Model performance in the validation cohort had an acceptable discrimination [AUC of 0.79; (95% confidence interval, 0.70 to 0.88)]. The Hosmer and Lemeshow goodness-of-fit test was not statistically significant, indicating good calibration of the model (χ2, 5 degrees of freedom = 2.311; P = 0.805). Conclusions: Our predictive simple score based on readily available clinical and laboratory data demonstrates a good performance when externally validated, namely with respect to discrimination and calibration. Model validation is crucial for adequately informing patients and their families about ESRD treatment options and providing a more patient-centered overall approach to care. Before we start general implementation in clinical practice, our score needs further validation in larger patient cohorts. |
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Validation of a model to predict six-month mortality in incident elderly dialysis patientsPrognosis ScoreEnd-Stage Renal DiseaseElderlyDecision MakingBackground and objectives: To evaluate RRT benefits and risks and to inform patients and their families about ESRD treatment options, we have developed a prognostic score to predict 6-month mortality in elderly ESRD patients initiating dialysis. Five independent predictors were identified and a point system was constructed: age 75 years or older (2 points), coronary artery disease (2 points), cerebrovascular disease with hemiplegia (2 points), time of nephrology care before dialysis [< 3.0 months (2 points); ≥ 3 to < 12 months (1 point)], serum albumin levels [3.0 - 3.49 g/dL (1 point); < 3.0 g/dL (2 points)]. Model performance was good in both discrimination and internal validation. Before adopting our risk score into practice, our aim is to externally validate this initial predictive model by assessing its performance on a new data set. Methods: We apply the predictive score developed in a cohort of CKD patients, aged 65 years and over who started dialysis between 2009 and 2016, to an independent cohort of ESRD patients, aged 65 years and over who started dialysis between 2017 and 2019, in our Nephrology department. The performance of the prediction equation created in development cohort, was assessed using discrimination and calibration metrics in the validation cohort. Results: Our validation study cohort included 168 individuals, with a mortality rate of 12.5% (n=21) within 6-months of dialysis initiation. Model performance in the validation cohort had an acceptable discrimination [AUC of 0.79; (95% confidence interval, 0.70 to 0.88)]. The Hosmer and Lemeshow goodness-of-fit test was not statistically significant, indicating good calibration of the model (χ2, 5 degrees of freedom = 2.311; P = 0.805). Conclusions: Our predictive simple score based on readily available clinical and laboratory data demonstrates a good performance when externally validated, namely with respect to discrimination and calibration. Model validation is crucial for adequately informing patients and their families about ESRD treatment options and providing a more patient-centered overall approach to care. Before we start general implementation in clinical practice, our score needs further validation in larger patient cohorts.Sociedade Portuguesa de Nefrologia2020-09-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articletext/htmlhttp://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692020000300001Portuguese Journal of Nephrology & Hypertension v.34 n.3 2020reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttp://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692020000300001Santos,JosefinaOliveira,PedroMalheiro,JorgeCampos,AndreiaCorreia,SofiaCabrita,AntónioLobato,LuísaFonseca,Isabelinfo:eu-repo/semantics/openAccess2024-02-06T17:05:06Zoai:scielo:S0872-01692020000300001Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T02:19:04.294401Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Validation of a model to predict six-month mortality in incident elderly dialysis patients |
title |
Validation of a model to predict six-month mortality in incident elderly dialysis patients |
spellingShingle |
Validation of a model to predict six-month mortality in incident elderly dialysis patients Santos,Josefina Prognosis Score End-Stage Renal Disease Elderly Decision Making |
title_short |
Validation of a model to predict six-month mortality in incident elderly dialysis patients |
title_full |
Validation of a model to predict six-month mortality in incident elderly dialysis patients |
title_fullStr |
Validation of a model to predict six-month mortality in incident elderly dialysis patients |
title_full_unstemmed |
Validation of a model to predict six-month mortality in incident elderly dialysis patients |
title_sort |
Validation of a model to predict six-month mortality in incident elderly dialysis patients |
author |
Santos,Josefina |
author_facet |
Santos,Josefina Oliveira,Pedro Malheiro,Jorge Campos,Andreia Correia,Sofia Cabrita,António Lobato,Luísa Fonseca,Isabel |
author_role |
author |
author2 |
Oliveira,Pedro Malheiro,Jorge Campos,Andreia Correia,Sofia Cabrita,António Lobato,Luísa Fonseca,Isabel |
author2_role |
author author author author author author author |
dc.contributor.author.fl_str_mv |
Santos,Josefina Oliveira,Pedro Malheiro,Jorge Campos,Andreia Correia,Sofia Cabrita,António Lobato,Luísa Fonseca,Isabel |
dc.subject.por.fl_str_mv |
Prognosis Score End-Stage Renal Disease Elderly Decision Making |
topic |
Prognosis Score End-Stage Renal Disease Elderly Decision Making |
description |
Background and objectives: To evaluate RRT benefits and risks and to inform patients and their families about ESRD treatment options, we have developed a prognostic score to predict 6-month mortality in elderly ESRD patients initiating dialysis. Five independent predictors were identified and a point system was constructed: age 75 years or older (2 points), coronary artery disease (2 points), cerebrovascular disease with hemiplegia (2 points), time of nephrology care before dialysis [< 3.0 months (2 points); ≥ 3 to < 12 months (1 point)], serum albumin levels [3.0 - 3.49 g/dL (1 point); < 3.0 g/dL (2 points)]. Model performance was good in both discrimination and internal validation. Before adopting our risk score into practice, our aim is to externally validate this initial predictive model by assessing its performance on a new data set. Methods: We apply the predictive score developed in a cohort of CKD patients, aged 65 years and over who started dialysis between 2009 and 2016, to an independent cohort of ESRD patients, aged 65 years and over who started dialysis between 2017 and 2019, in our Nephrology department. The performance of the prediction equation created in development cohort, was assessed using discrimination and calibration metrics in the validation cohort. Results: Our validation study cohort included 168 individuals, with a mortality rate of 12.5% (n=21) within 6-months of dialysis initiation. Model performance in the validation cohort had an acceptable discrimination [AUC of 0.79; (95% confidence interval, 0.70 to 0.88)]. The Hosmer and Lemeshow goodness-of-fit test was not statistically significant, indicating good calibration of the model (χ2, 5 degrees of freedom = 2.311; P = 0.805). Conclusions: Our predictive simple score based on readily available clinical and laboratory data demonstrates a good performance when externally validated, namely with respect to discrimination and calibration. Model validation is crucial for adequately informing patients and their families about ESRD treatment options and providing a more patient-centered overall approach to care. Before we start general implementation in clinical practice, our score needs further validation in larger patient cohorts. |
publishDate |
2020 |
dc.date.none.fl_str_mv |
2020-09-01 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692020000300001 |
url |
http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692020000300001 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692020000300001 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Sociedade Portuguesa de Nefrologia |
publisher.none.fl_str_mv |
Sociedade Portuguesa de Nefrologia |
dc.source.none.fl_str_mv |
Portuguese Journal of Nephrology & Hypertension v.34 n.3 2020 reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
instname_str |
Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
collection |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository.name.fl_str_mv |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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1799137280226492416 |