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Yen HY, Chi MJ, Huang HY. Effects of discharge planning services and unplanned readmissions on post-hospital mortality in older patients: a time-varying survival analysis. Int J Nurs Stud 2022; 128:104175. [DOI: 10.1016/j.ijnurstu.2022.104175] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/16/2021] [Accepted: 01/08/2022] [Indexed: 12/11/2022]
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Bernabeu-Wittel M, Ternero-Vega JE, Díaz-Jiménez P, Conde-Guzmán C, Nieto-Martín MD, Moreno-Gaviño L, Delgado-Cuesta J, Rincón-Gómez M, Giménez-Miranda L, Navarro-Amuedo MD, Muñoz-García MM, Calzón-Fernández S, Ollero-Baturone M. Death risk stratification in elderly patients with covid-19. A comparative cohort study in nursing homes outbreaks. Arch Gerontol Geriatr 2020; 91:104240. [PMID: 32877792 PMCID: PMC7446617 DOI: 10.1016/j.archger.2020.104240] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/01/2020] [Accepted: 08/21/2020] [Indexed: 12/13/2022]
Abstract
Elderly people are more severely affected by COVID-19. Nevertheless scarce information about specific prognostic scores for this population is available. The main objective was to compare the accuracy of recently developed COVID-19 prognostic scores to that of CURB-65, Charlson and PROFUND indices in a cohort of 272 elderly patients from four nursing homes, affected by COVID-19. Accuracy was measured by calibration (calibration curves and Hosmer-Lemeshov (H-L) test), and discriminative power (area under the receiver operation curve (AUC-ROC). Negative and positive predictive values (NPV and PPV) were also obtained. Overall mortality rate was 22.4 %. Only ACP and Shi et al. out of 10 specific COVID-19 indices could be assessed. All indices but CURB-65 showed a good calibration by H-L test, whilst PROFUND, ACP and CURB-65 showed best results in calibration curves. Only CURB-65 (AUC-ROC = 0.81 [0.75-0.87])) and PROFUND (AUC-ROC = 0.67 [0.6-0.75])) showed good discrimination power. The highest NPV was obtained by CURB-65 (95 % [90-98%]), PROFUND (93 % [77-98%]), and their combination (100 % [82-100%]); whereas CURB-65 (74 % [51-88%]), and its combination with PROFUND (80 % [50-94%]) showed highest PPV. PROFUND and CURB-65 indices showed the highest accuracy in predicting death-risk of elderly patients affected by COVID-19, whereas Charlson and recent developed COVID-19 specific tools lacked it, or were not available to assess. A comprehensive clinical stratification on two-level basis (basal death risk due to chronic conditions by PROFUND index, plus current death risk due to COVID-19 by CURB-65), could be an appropriate approach.
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Affiliation(s)
- M Bernabeu-Wittel
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain; Department of Medicine, University of Seville, Spain. https://mobile.twitter.com/mximowittel?lang=en
| | - J E Ternero-Vega
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
| | - P Díaz-Jiménez
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
| | - C Conde-Guzmán
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
| | - M D Nieto-Martín
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
| | - L Moreno-Gaviño
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
| | - J Delgado-Cuesta
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
| | - M Rincón-Gómez
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
| | - L Giménez-Miranda
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
| | - M D Navarro-Amuedo
- Infectious Diseases Department, University Hospital Virgen del Rocío, Seville, Spain
| | - M M Muñoz-García
- Bermejales Primary Care Center, Primary Care District of Seville, Spain
| | - S Calzón-Fernández
- Epidemiology and Public Health Department, Primary Care District of Seville, Spain
| | - M Ollero-Baturone
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
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