title: A prognostic model for 6-month mortality in elderly survivors of critical illness.
abstract: BACKGROUND
  Although 1.4 million elderly Americans survive hospitalization involving intensive care annually, many are at risk for early mortality following discharge. No models that predict the likelihood of death after discharge exist explicitly for this population. Therefore, we derived and externally validated a 6-month postdischarge mortality prediction model for elderly ICU survivors.
  
  
  METHODS
  We derived the model from medical record and claims data for 1,526 consecutive patients aged ≥ 65 years who had their first medical ICU admission in 2006 to 2009 at a tertiary-care hospital and survived to discharge (excluding those patients discharged to hospice). We then validated the model in 1,010 patients from a different tertiary-care hospital.
  
  
  RESULTS
  Six-month mortality was 27.3% and 30.2% in the derivation and validation cohorts, respectively. Independent predictors of mortality (in descending order of contribution to the model's predictive power) were a do-not-resuscitate order, older age, burden of comorbidity, admission from or discharge to a skilled-care facility, hospital length of stay, principal diagnoses of sepsis and hematologic malignancy, and male sex. For the derivation and external validation cohorts, the area under the receiver operating characteristic curve was 0.80 (SE, 0.01) and 0.71 (SE, 0.02), respectively, with good calibration for both (P = 0.31 and 0.43).
  
  
  CONCLUSIONS
  Clinical variables available at hospital discharge can help predict 6-month mortality for elderly ICU survivors. Variables that capture elements of frailty, disability, the burden of comorbidity, and patient preferences regarding resuscitation during the hospitalization contribute most to this model's predictive power. The model could aid providers in counseling elderly ICU survivors at high risk of death and their families.
authors: Division of Pulmonary, Allergy, and Critical Care, Columbia University, New York, NY. Electronic address: mrb45@columbia.edu.
authors: Matthew R
authors: MR
authors: Baldwin
authors: Data Analytics Group, New York-Presbyterian Hospital, New York, NY.
authors: Wazim R
authors: WR
authors: Narain
authors: Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY; Department of Epidemiology, New York, NY.
authors: Hannah
authors: H
authors: Wunsch
authors: Division of Pulmonary, Allergy, and Critical Care, Columbia University, New York, NY; Department of Epidemiology, New York, NY.
authors: Neil W
authors: NW
authors: Schluger
authors: Division of Pulmonary and Critical Care, Weill Cornell Medical College, New York, NY.
authors: Joseph T
authors: JT
authors: Cooke
authors: Division of Cardiology, College of Physicians and Surgeons, Columbia University, New York, NY.
authors: Mathew S
authors: MS
authors: Maurer
authors: Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY.
authors: John W
authors: JW
authors: Rowe
authors: Division of Pulmonary, Allergy, and Critical Care, Columbia University, New York, NY; Department of Epidemiology, New York, NY.
authors: David J
authors: DJ
authors: Lederer
authors: Center for Health Policy and Outcomes, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors: Peter B
authors: PB
authors: Bach
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D015233:Models, Statistical; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011379:Prognosis; D016414:Resuscitation Orders; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors
references: Crit Care Med. 2012 Apr;40(4):1171-6
references: 22080643
references: JAMA. 1963 Sep 21;185:914-9
references: 14044222
references: Chest. 1991 Dec;100(6):1619-36
references: 1959406
references: J Gerontol A Biol Sci Med Sci. 2004 Mar;59(3):255-63
references: 15031310
references: Crit Care. 2011;15(1):301
references: 21345259
references: Crit Care Med. 2008 May;36(5):1523-30
references: 18434893
references: Proc Natl Acad Sci U S A. 2008 Mar 18;105(11):4318-22
references: 18334646
references: J Am Coll Surg. 2010 Jun;210(6):901-8
references: 20510798
references: Anaesth Intensive Care. 2012 Mar;40(2):236-46
references: 22417017
references: Am J Respir Crit Care Med. 2010 Oct 15;182(8):995-1003
references: 20558632
references: J Am Geriatr Soc. 2011 Nov;59(11):2129-38
references: 22091630
references: Crit Care Med. 2001 Jul;29(7):1303-10
references: 11445675
references: Crit Care Med. 2010 Sep;38(9):1765-72
references: 20562699
references: JAMA. 2010 Jun 9;303(22):2253-9
references: 20530778
references: Am J Respir Crit Care Med. 2010 May 15;181(10):1121-7
references: 20224063
references: Chest. 2011 Jan;139(1):88-94
references: 20688920
references: J Crit Care. 2005 Mar;20(1):79-89
references: 16015521
references: J Chronic Dis. 1987;40(5):373-83
references: 3558716
references: J Appl Physiol (1985). 2000 Oct;89(4):1365-79
references: 11007571
references: Crit Care Med. 1985 Oct;13(10):818-29
references: 3928249
references: Crit Care Med. 2010 Dec;38(12):2319-28
references: 20890195
references: JAMA. 2010 Mar 3;303(9):849-56
references: 20197531
references: J Gerontol A Biol Sci Med Sci. 2013 Mar;68(3):301-8
references: 22843671
references: Chest. 2008 Jun;133(6):1312-1318
references: 18198259
references: Chest. 2001 Sep;120(3):928-33
references: 11555531
references: J Clin Epidemiol. 2001 Aug;54(8):774-81
references: 11470385
references: JAMA. 1998 Apr 15;279(15):1187-93
references: 9555758
references: Ann Intern Med. 2010 Aug 3;153(3):204-5
references: 20679565
references: JAMA. 2001 Jun 20;285(23):2987-94
references: 11410097
references: Crit Care Med. 2006 Apr;34(4):1016-24
references: 16505703
references: Am J Respir Crit Care Med. 2012 Jan 1;185(1):96-102
references: 22210788
references: Arch Intern Med. 2007 Mar 12;167(5):461-7
references: 17353493
references: J Gerontol A Biol Sci Med Sci. 2001 Mar;56(3):M146-56
references: 11253156
references: J Am Geriatr Soc. 2006 Jul;54(7):1031-9
references: 16866672
references: BMJ. 2004 Mar 13;328(7440):607
references: 15016692
references: J Am Coll Cardiol. 2006 Feb 21;47(4):757-63
references: 16487841
references: JAMA. 1993 Dec 22-29;270(24):2957-63
references: 8254858
references: Ann Intern Med. 2008 Nov 4;149(9):601-11
references: 18981485
references: Crit Care Med. 2010 Jan;38(1):59-64
references: 19633539
references: J Am Med Dir Assoc. 2007 Nov;8(9):595-603
references: 17998116
references: JAMA. 1995 Nov 22-29;274(20):1591-8
references: 7474243
references: N Engl J Med. 2002 Apr 4;346(14):1061-6
references: 11932474
references: Crit Care Med. 2006 May;34(5):1297-310
references: 16540951
references: Curr Opin Crit Care. 2002 Aug;8(4):321-30
references: 12386493