Predictive Value of a Profile of Routine Blood Measurements on Mortality in Older Persons in the General Population: The Leiden 85-Plus Study

Anne H Van Houwelingen,Anton J M De Craen,Jacobijn Gussekloo,Jeanet W Blom,Margot Heijmans,Simon P Mooijaart,Wendy P.J Den Elzen,Antony Bayer

doi:10.1371/journal.pone.0058050

Anne H Van Houwelingen, Anton J M De Craen + Show 6 more

Open Access

https://doi.org/10.1371/journal.pone.0058050

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Journal: PloS one	Publication Date: Mar 4, 2013
Citations: 52	License type: CC BY 4.0

Affiliation: Leiden University Medical Center

Abstract

BackgroundVarious questionnaires and performance tests predict mortality in older people. However, most are heterogeneous, laborious and a validated consensus index is not available yet. Since most older people are regularly monitored by laboratory tests, we compared the predictive value of a profile of seven routine laboratory measurements on mortality in older persons in the general population with other predictors of mortality; gait speed and disability in instrumental activities of daily living (IADL).Methodology/Principal FindingsWithin the Leiden 85-plus Study, a prospective population-based study, we followed 562 participants aged 85 years for mortality over five years. At baseline (age 85 years) high-density lipoprotein cholesterol, albumin, alanine transaminase, hemoglobin, creatinin clearance, C-reactive protein and homocysteine were measured. Participants were stratified based on their number of laboratory abnormalities (0, 1, 2–4 and 5–7). The predictive capacity was compared with gait speed (6-meter walking test) and disability in IADL (Groningen Activity Restriction Scale) by C-statistics. At baseline, 418 (74%) 85-year old participants had at least one laboratory abnormality. All cause mortality risk increased with increasing number of laboratory abnormalities to a hazard ratio of 5.64 [95% CI 3.49–9.12] for those with 5–7 laboratory abnormalities (p<0.001) compared to those without abnormalities. The c-statistic was 0.66 [95% CI 0.59–0.69], similar to that of gait speed and disability in IADL.Conclusions/SignificanceIn the general population of oldest old, the number of abnormalities in seven routine laboratory measurements predicts five-year mortality as accurately as gait speed and IADL disability.

Highlights

Prognostic information about life expectancy in older people is important in clinical decision-making because this population is very heterogeneous
When comparing the predictive value of the laboratory profile with the models on gait speed and ability in instrumental activities of daily living (IADL) with receiver operation characteristic (ROC) curves (Figure 2), the c-statistic for the laboratory profile was 0.66, for the sex-dependent quartiles of 6-m gait speed it was 0.68 and for sex-dependent quartiles of ability in IADL it was 0.69
In this population-based study of very old people, the number of abnormalities in a profile of seven routine laboratory measurements is a robust predictor of all-cause mortality

Summary

Introduction

Prognostic information about life expectancy in older people is important in clinical decision-making because this population is very heterogeneous. Self-reported questionnaires and performance tests are often used to identify older people at risk for mortality [4,5,6]. These instruments are heterogeneous and a consensus index is not yet available [4,5,6]. Since most older people are regularly monitored by laboratory tests, we compared the predictive value of a profile of seven routine laboratory measurements on mortality in older persons in the general population with other predictors of mortality; gait speed and disability in instrumental activities of daily living (IADL)

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