Predictors of in-hospital mortality among older patients.
OBJECTIVE
The objective of this study was to determine predictors of in-hospital mortality among older patients admitted to a geriatric care unit.


BACKGROUND
The growing number of older individuals among hospitalized patients demands a thorough investigation of the factors that contribute to their mortality.


METHODS
This was a prospective observational study implemented from February 2004 to October 2007 in a tertiary university hospital. A consecutive sample of 922 patients was evaluated for possible inclusion in this study. Patients hospitalized for palliative care, those who declined to participate, and those with incomplete data were excluded, resulting in a group of 856 patients aged 60 to 104 years. Bivariate and multivariate analyses were performed to determine associations between in-patient mortality and gender, age, length of stay, number of prescribed medications and diagnoses at admission, history of heart failure, neoplastic disease, immobility syndrome, delirium, infectious disease, and laboratory tests at admission (serum albumin and creatinine).


RESULTS
The overall mortality rate was 16.4%. The following factors were associated with higher in-hospital mortality: delirium (OR=4.13, CI=2.65-6.44, P<.001), neoplastic disease (OR=3.38, CI=2.11-5.42, P<.001), serum albumin levels at admission < 3.3 mg/dL (OR=3.23, CI=2.03-5.13, P<.001), serum creatinine levels at admission > or = 1.3 mg/dL (OR=2.39, CI=1.53-3.72, P<.001), history of heart failure (OR=1.97, CI=1.20-3.22, P=.007), immobility (OR=1.84, CI=1.16-2.92, P =.009), and advanced age (OR=1.03, CI=1.01-1.06, P=.019).


CONCLUSIONS
This study strengthens the perception of delirium as a mortality predictor among older inpatients. Cancer, immobility, low albumin levels, elevated creatinine levels, history of heart failure and advanced age were also related to higher mortality rates in this population.
Silva
Thiago J A
TJ
Geriatric Service, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo/SP, Brazil. tsilva87@gmail.com
Jerussalmy
Cláudia Szlejf
CS
Farfel
José M
JM
Curiati
José A E
JA
Jacob-Filho
Wilson
W
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D003693:Delirium / Q000401:mortality; D004812:Epidemiologic Methods; D005260:Female; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000401:mortality; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality; D012709:Serum Albumin; D012737:Sex Factors
D012709:Serum Albumin