Primary Care Prognostic (PCP) Index of 11-Year Mortality Risk: Development and Validation of a Brief Prognostic Tool

​Background
Healthcare providers use a life expectancy of at least 5 to 10 years in shared clinical decision-making with older adults about cancer screening, major surgeries, and disease prevention interventions. At present, few prognostic indexes predict long-term mortality beyond 10 years or are suited for use in primary care settings.

Objective
We developed and validated an 8-item multidimensional index predicting 11-year mortality for use in primary care.

Design, Setting, and Participants
Using data from the Singapore Longitudinal Ageing Studies (SLAS), we developed a Primary care Prognostic (PCP) Index for predicting 11-year mortality risk in a development cohort (n = 155) and validated it in a geographically different cohort (n = 928).

Main Measures

The PCP Index was derived from eight indicators (body mass low, weakness, slow gait, comorbidity, polypharmacy, IADL/BADL dependency, low albumin, low total cholesterol, out of 25 candidate indicators) using stepwise Cox proportional hazard models.

Key Results

In the developmental cohort, the mortality hazard ratio increased by 53% per PCP point score increase, independent of age and sex. Across risk categories, absolute risks of mortality increased from 5% (score 0) to 67.9% (scores 7-9), with area under curve (AUC = 0.77 (95% CI 0.73-0..80)). The PCP Index also predicted mortality in the validation cohort, with AUC = 0.70 (95% CI 0.64 - 0.75).

Conclusions
The PCP Index using simple clinical assessments and point scoring is a potentially useful prognostic tool for predicting long-term mortality and is well suited for risk stratification and shared clinical decision-making with older adults in primary care.

SOURCE:
Journal of General Internal Medicine

DOI:
https://doi.org/10.1007/s11606-020-06132-2

AUTHOR(S):
Chiang GSH, Nyunt MSZ, Gao Q, Wee SL, Yap KB, Tan BY, Ng TP