{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T10:27:28Z","timestamp":1769509648598,"version":"3.49.0"},"reference-count":48,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2021,1,20]],"date-time":"2021-01-20T00:00:00Z","timestamp":1611100800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"crossref","award":["K23AG051679"],"award-info":[{"award-number":["K23AG051679"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["K23 DK109134"],"award-info":[{"award-number":["K23 DK109134"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1 TR000135"],"award-info":[{"award-number":["UL1 TR000135"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Rational and objective<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Study design<\/jats:title><jats:p>Validation study of prognostic indices using retrospective cohort data. Indices were compared using the concordance (\u201cc\u201d)-statistic, i.e. area under the receiver operating characteristic curve (ROC). Calibration, sensitivity, specificity, positive and negative predictive values were also calculated.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Setting &amp; participants<\/jats:title><jats:p>Incident elderly (age \u226575 years; n = 349) dialysis patients at a tertiary referral center.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Established predictors<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec id=\"sec005\"><jats:title>Results<\/jats:title><jats:p>In our cohort of 349 patients, mean age was 81.5\u00b14.4 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 &lt;0.01) and overestimated mortality risk, while the Wick index was relatively well-calibrated but underestimated mortality risk.<\/jats:p><\/jats:sec><jats:sec id=\"sec006\"><jats:title>Limitations<\/jats:title><jats:p>Small sample size, use of secondary data, need for imputation, homogeneous population.<\/jats:p><\/jats:sec><jats:sec id=\"sec007\"><jats:title>Conclusion<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0244081","type":"journal-article","created":{"date-parts":[[2021,1,20]],"date-time":"2021-01-20T19:26:26Z","timestamp":1611170786000},"page":"e0244081","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["Validation of prognostic indices for short term mortality in an incident dialysis population of older adults &gt;75"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4397-728X","authenticated-orcid":true,"given":"Bjorg","family":"Thorsteinsdottir","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"LaTonya J.","family":"Hickson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel","family":"Giblon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atieh","family":"Pajouhi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natalie","family":"Connell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Megan","family":"Branda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amrit K.","family":"Vasdev","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rozalina G.","family":"McCoy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ladan","family":"Zand","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Navdeep","family":"Tangri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nilay D.","family":"Shah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,1,20]]},"reference":[{"key":"pone.0244081.ref001","volume-title":"Shared Decision-Making in the Appropriate Initiation of and Withdrawal from Dialysis. 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