Prediction of mortality 1 year after hospital admission.
OBJECTIVE
Hospital admission, especially for the elderly, can be a seminal event as many patients die within a year. This study reports the prediction of death within a year of admission to hospital of the Simple Clinical Score (SCS) and ECG dispersion mapping (ECG-DM). ECG-DM is a novel technique that analyzes low-amplitude ECG oscillations and reports them as the myocardial micro-alternation index (MMI).


METHODS
a convenient sample of 430 acutely ill medical patients (mean age 67.9 ± 16.6 years) was followed up for 1 year after their last admission to hospital.


RESULTS
Seventy-four (16.3%) patients died within a year-all but seven had a SCS ≥5 and 40% of those with an MMI ≥50% died. Only six of variables were found by logistic regression to be independent predictors of mortality (i.e. age, MMI, SCS, a discharge diagnosis of cancer, hemoglobin <11 gm% and prior illness that required the patient to spend >50% of daytime in bed). The SCS and MMI plus age were comparable predictors of 1-year mortality: SCS ≥12 predicted 1-year mortality with the highest odds (16.1, chi square 79.09, p < 0.0001) and a score of age plus MMI >104 had an odds ratio of 9.4 (chi square 73.50, p < 0.0001), identified 69% of deaths, and 43% of the 119 patients who exceeded this score were dead within a year.


CONCLUSIONS
SCS and ECG-DM plus age are clinically useful for long-term prognostication. ECG-DM is inexpensive, only takes a few seconds to perform and requires no skill to interpret.
Department of Medicine, Nenagh Hospital, Nenagh, County Tipperary, Ireland. jgkellett@eircom.net
J
J
Kellett
S
S
Rasool
B
B
McLoughlin
D000208:Acute Disease / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004562:Electrocardiography; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006769:Hospitals, General / Q000706:statistics & numerical data; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008017:Life Expectancy; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index; D055815:Young Adult