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

Autor: Bas de Groot, Noor Heim, Antonius J. M. de Craen, Jelle de Gelder, Shantaily D. Lourens, Ewout W. Steyerberg, Jacinta A. Lucke, Anne J Fogteloo, Simon P. Mooijaart, Gerard J. Blauw
Přispěvatelé: Public Health
Jazyk: angličtina
Rok vydání: 2016
Předmět:
Pediatrics
Psychological intervention
Disease
Comorbidity
030204 cardiovascular system & hematology
EM - Original
0302 clinical medicine
Elderly
Risk Factors
Medicine
030212 general & internal medicine
Hospital Mortality
Acute hospitalization
ELDERLY-PATIENTS
Oxygen saturation (medicine)
Netherlands
RISK
OUTCOMES
Prognosis
ADMISSION
Predictive value of tests
Older adults
Emergency Medicine
Female
Life Sciences & Biomedicine
medicine.medical_specialty
Vital signs
VALIDATION
MORBIDITY
03 medical and health sciences
Medicine
General & Internal
PEOPLE
Predictive Value of Tests
General & Internal Medicine
SCORE
Internal Medicine
Humans
Mortality
Geriatric Assessment
Aged
Retrospective Studies
Polypharmacy
Science & Technology
IDENTIFICATION
business.industry
Diagnostic Tests
Routine
Vital Signs
Retrospective cohort study
medicine.disease
business
Prediction
Biomarkers
ACUTE MEDICAL UNIT
Zdroj: Internal and Emergency Medicine
Internal and Emergency Medicine, 11(4), 587-594. Springer-Verlag Italia
Internal and Emergency Medicine, 11(4), 587-594
ISSN: 1828-0447
Popis: 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 material The online version of this article (doi:10.1007/s11739-015-1381-7) contains supplementary material, which is available to authorized users.
Databáze: OpenAIRE
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