Predicting mortality in acutely hospitalized older patients: a retrospective cohort study.

Jelle De Gelder,Anne J Fogteloo,Gerard J Blauw,Simon P Mooijaart,Ewout W Steyerberg,Shantaily D Lourens,Noor Heim,Antonius J M De Craen,Jacinta A Lucke,Bas De Groot

doi:10.1007/s11739-015-1381-7

Jelle De Gelder, Anne J Fogteloo + Show 8 more

Open Access

https://doi.org/10.1007/s11739-015-1381-7

Copy DOI

Abstract

Acutely hospitalized older patients have an increased risk of mortality, but at the moment of presentation this risk is difficult to assess. Early identification of patients at high risk might increase the awareness of the physician, and enable tailored decision-making. Existing screening instruments mainly use either geriatric factors or severity of disease for prognostication. Predictive performance of these instruments is moderate, which hampers successive interventions. We conducted a retrospective cohort study among all patients aged 70 years and over who were acutely hospitalized in the Acute Medical Unit of the Leiden University Medical Center, the Netherlands in 2012. We developed a prediction model for 90-day mortality that combines vital signs and laboratory test results reflecting severity of disease with geriatric factors, represented by comorbidities and number of medications. Among 517 patients, 94 patients (18.2 %) died within 90 days after admission. Six predictors of mortality were included in a model for mortality: oxygen saturation, Charlson comorbidity index, thrombocytes, urea, C-reactive protein and non-fasting glucose. The prediction model performs satisfactorily with an 0.738 (0.667–0.798). Using this model, 53 % of the patients in the highest risk decile (N = 51) were deceased within 90 days. In conclusion, we are able to predict 90-day mortality in acutely hospitalized older patients using a model with directly available clinical data describing disease severity and geriatric factors. After further validation, such a model might be used in clinical decision making in older patients.Electronic supplementary materialThe online version of this article (doi:10.1007/s11739-015-1381-7) contains supplementary material, which is available to authorized users.

Highlights

Electronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.Acute medical illness in older adults is a serious contributor to deterioration [1]
We developed a prediction model for 90-day mortality in acutely hospitalized older patients using routinely collected clinical parameters describing disease severity and geriatric factors
We developed and internally validated a prediction model for 90-day mortality in acutely hospitalized older patients using six routinely collected clinical parameters and with adding age and gender

Summary

Introduction

Electronic supplementary material The online version of this article (doi:10.1007/s11739-015-1381-7) contains supplementary material, which is available to authorized users. Acute medical illness in older adults is a serious contributor to deterioration [1]. Within 90 days after hospitalization, approximately 20 % will die [2, 3]. At the time of admission it is difficult to determine who is at highest risk. Visualizing the individual risk in an early phase of hospitalization might increase the awareness of the physician, and enable tailored decision-making for the older patient, these interventions may not primarily be aimed at reducing mortality. A high risk of mortality may reflect overall vulnerability, which preventive interventions may be aimed at, or by usefully initiating palliative care

Objectives

Methods

Results

Conclusion