A simple 5-point scoring system, NaURSE (Na+, urea, respiratory rate and shock index in the elderly), predicts in-hospital mortality in oldest old.
BACKGROUND
the mortality is high in acutely ill oldest old patients. Understanding the prognostic factors which influence mortality will help clinicians make appropriate management decisions.


METHODS
we analysed prospective mortality audit data (November 2008 to January 2009) to identify variables associated with in-patient mortality in oldest old. We selected those with P < 0.10 from univariate analysis and determined at which cut-point they served as the strongest predictor of mortality. Using these cut-off points, we constructed multivariate logistic regression models. A 5-point score was derived from cut-off points which were significantly associated with mortality tested in a smaller independent re-audit sample conducted in October 2011.


RESULTS
a total of 405 patients (mean 93.5 ± 2.7 years) were included in the study. The mean length of stay was 18.5 ± 42.4 days and 13.8% died as in-patients. Variables (cut-off values) found to be significantly associated with in-patient mortality were admission sodium (>145 mmol/l), urea (≥14 mmol/l), respiratory rate (>20/min) and shock index (>1.0): creating a 5-point score (NaURSE: NaURS in the Elderly). The crude mortality rates were 9.5, 19.9, 34.4, 66.7, and 100% for scores 0, 1, 2, 3 and 4, respectively. Using the cut-off point of ≥2, the NaURSE score has a specificity of 87% (83.1-90.3) and sensitivity of 39% (28.5-50.0), with an AUC value of 0.69 (0.63-0.76). An external independent validation study (n = 121) showed similar results.


CONCLUSIONS
the NaURSE score may be particularly useful in identifying oldest old who are likely to die in that admission to guide appropriate care.
Academic Department of Medicine for the Elderly, Norfolk and Norwich University Hospital, Norwich, UK.
Alexander H
AH
Wilson
Andrew C
AC
Kidd
Jane
J
Skinner
Patrick
P
Musonda
Yogish
Y
Pai
Claire J
CJ
Lunt
Catherine
C
Butchart
Roy L
RL
Soiza
John F
JF
Potter
Phyo Kyaw
PK
Myint
D000208:Acute Disease / Q000401:mortality / Q000628:therapy; D000369:Aged, 80 and over; D054869:Clinical Audit / Q000706:statistics & numerical data; D003661:Decision Support Techniques; D019468:Disease Management; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D011379:Prognosis; D056152:Respiratory Rate; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index; D012769:Shock / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D012964:Sodium / Q000097:blood*; D006113:United Kingdom / Q000453:epidemiology; D014508:Urea / Q000097:blood*
D014508:Urea; D012964:Sodium
mortality; older people; oldest old; prognostic score