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Predictive Value of Incorporating Principal Diagnosis into CGA for Short-Term Functional Recovery in an ACE Unit: A
Li Chen1, Dongyan Pu2, Guiqing Wang1
1Department of Geriatrics, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, 450001, People's Republic of China.
Clinical Interventions in Aging
|June 9, 2026
Summary
Principal diagnosis better predicts short-term functional recovery in Acute Care for Elders (ACE) units than Charlson Comorbidity Index (CCI). This finding enhances geriatric assessment for older adults.
Area of Science:
- Geriatric Medicine
- Internal Medicine
- Health Services Research
Background:
- Comprehensive Geriatric Assessment (CGA) in Acute Care for Elders (ACE) units often uses cumulative comorbidity metrics like Charlson Comorbidity Index (CCI).
- Existing metrics like CCI may not capture the dynamic nature of acute illness, limiting their predictive accuracy for short-term functional recovery in older adults.
Purpose of the Study:
- To evaluate if the principal diagnosis, reflecting acute physiological stress, is a superior predictor of functional outcomes compared to CCI in hospitalized older adults.
- To assess the predictive value of principal diagnosis versus CCI for short-term functional recovery in the ACE unit setting.
Main Methods:
- Retrospective cohort study of 213 patients (≥65 years) admitted to an ACE unit.
- Primary outcome: short-term functional recovery measured by change in Barthel Index (BI) from admission to discharge (ΔBI).
- Hierarchical multiple linear regression models were used, comparing base, CCI, and principal diagnosis models; performance assessed by Adjusted R², AUC, NRI, and AIC/BIC.
Main Results:
- The principal diagnosis model showed higher explanatory power (Adjusted R² = 0.85) than the CCI model (Adjusted R² = 0.78) and base model (Adjusted R² = 0.75).
- Principal diagnosis inclusion significantly improved reclassification (NRI=0.37, p = 0.006).
- Specific diagnoses (e.g., Endocrine, Respiratory) were significant predictors of recovery, while CCI was not.
Conclusions:
- Principal diagnosis is a more effective predictor of short-term functional recovery in ACE units than cumulative comorbidity measures.
- Integrating principal diagnosis into CGA offers a practical enhancement for early functional prognostication in hospitalized older adults.
