Abstract
BackgroundSeveral factors have been associated with mortality prediction among older inpatients. The objective of this study was to assess the factors associated with mortality in hospitalized elderly patients.MethodsA total of 353 consecutively admitted elderly patients (47.9% women), with a median age of 83 years (interquartile range 75.00-88.00), were enrolled in the study and patient characteristics were recorded. Comorbidities were assessed using Charlson Comorbidity Index (CCI), activities of daily living by Barthel Index (BI), frailty was assessed using the Clinical Frailty Scale (CFS), cognition by Global Deterioration Scale (GDS) and symptom severity at admission by quick Sequential Organ Function Assessment (qSOFA) score. CFS, GDS and BI were estimated for the premorbid patients’ status. Parametric and non-parametric tests and binary logistic regression analysis were applied to identify the factors associated with mortality. A receiver operating characteristic (ROC) curve was used to analyse the prognostic value of CFS and qSOFA.ResultsIn total, 55 patients (15.6%) died during hospitalization. In regression analysis, the factors associated with mortality were the qSOFA score at admission (p=0.001, odds ratio [OR]=1.895, 95% confidence interval [CI] 1.282-2.802) and the premorbid CFS score (p=0.001, OR=1.549, 95% CI 1.1204-1.994). The classifiers both have almost similar area under the curve (AUC) scores, with CFS performing slightly better. More specifically, both CFS (AUC 0.79, 95% CI 0.73-0.85, p=0.001) and qSOFA (AUC 0.75, 95% CI 0.67-0.83, p<0.001) showed almost the same accuracy for predicting inpatients’ mortality.ConclusionThis study strengthens the perception of premorbid frailty and disease severity at admission as factors closely related to mortality in hospitalized elderly patients. Simple measures such as CFS and qSOFA score may help identify, in the emergency department, elderly patients at risk, in order to provide timely interventions.
Highlights
IntroductionThe evaluation of elderlies at the emergency department is complicated because along with the acute pathological conditions that lead them to the hospital, there is an underlying premorbid health status that plays a significant role [3]
Compared with younger patients, older persons who attend the emergency department are often sicker, more likely to stay longer in the emergency room and more likely to be admitted to the hospital [1]
The factors associated with mortality were the quick Sequential Organ Function Assessment (qSOFA) score at admission (p=0.001, odds ratio [odds ratios (OR)]=1.895, 95% confidence interval [confidence intervals (CIs)] 1.282-2.802) and the premorbid Clinical Frailty Scale (CFS) score (p=0.001, OR=1.549, 95% CI 1.1204-1.994)
Summary
The evaluation of elderlies at the emergency department is complicated because along with the acute pathological conditions that lead them to the hospital, there is an underlying premorbid health status that plays a significant role [3]. In this time-pressure setting, the early identification of older patients at higher risk of poor outcomes is critical [4]. Identifying those patients may help provide timely interventions to reduce mortality [5]. The objective of this study was to assess the factors associated with mortality in hospitalized elderly patients
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