title: Hypotension, bedridden, leukocytosis, thrombocytopenia and elevated serum creatinine predict mortality in geriatric patients with fever.
abstract: OBJECTIVE
  The geriatric population (aged ≥65 years) accounts for 12-24% of all emergency department (ED) visits. Of them, 10% have a fever, 70-90% will be admitted and 7-10% of will die within a month. Therefore, mortality prediction and appropriate disposition after ED treatment are of great concern for geriatric patients with fever. We tried to identify independent mortality predictors of geriatric patients with fever, and combine these predictors to predict their mortality.
  
  
  METHODS
  We enrolled consecutive geriatric patients visiting the ED between 1 June and 21 July 2010 with the following criteria of fever: a tympanic temperature ≥37.2°C or a baseline temperature elevated ≥1.3°C. We used 30-day mortality as the primary end-point.
  
  
  RESULTS
  A total of 330 patients were enrolled. Hypotension, bedridden, leukocytosis, thrombocytopenia and serum creatinine >2 mg/dL, but not age, were independently associated with 30-day mortality. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) ranged from 18.2% to 90.9%, 34.7% to 100%, 9.0% to 100% and 94.5% to 98.2%, respectively, depending on how many predictors there were.
  
  
  CONCLUSIONS
  The 30-day mortality increased with the number of independent mortality predictors. With at least four predictors, 100% of the patients died within 30 days. With none of the predictors, just 1.8% died. These findings might help physicians make decisions about geriatric patients with fever.
authors.affiliation: Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan.|Department of Emergency Medicine, Chi-Mei Medical Center, Liouying, Tainan, Taiwan.
authors.forename: Min-Hsien
authors.initials: MH
authors.lastname: Chung
authors.affiliation: Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan.|Department of Emergency Medicine, Chi-Mei Medical Center, Chiali, Tainan, Taiwan.
authors.forename: Feng-Yuan
authors.initials: FY
authors.lastname: Chu
authors.affiliation: Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Tzu-Meng
authors.initials: TM
authors.lastname: Yang
authors.affiliation: Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan.|Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.|Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Hung-Jung
authors.initials: HJ
authors.lastname: Lin
authors.affiliation: Department of Emergency Medicine, Cathay General Hospital, Taipei, Taiwan.|Fu Jen Catholic University School of Medicine, Taipei, Taiwan.
authors.forename: Jiann-Hwa
authors.initials: JH
authors.lastname: Chen
authors.affiliation: Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.|Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: How-Ran
authors.initials: HR
authors.lastname: Guo
authors.affiliation: Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan.|Department of Emergency Medicine, Chi-Mei Medical Center, Liouying, Tainan, Taiwan.
authors.forename: Si-Chon
authors.initials: SC
authors.lastname: Vong
authors.affiliation: Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan.|Medical Research, Chi-Mei Medical Center, Tainan, Taiwan.|Department of Leisure, Recreation and Tourism Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
authors.forename: Shih-Bin
authors.initials: SB
authors.lastname: Su
authors.affiliation: Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan.|Child Care and Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan.|Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.|Department of Emergency Medicine, Kuo General Hospital, Tainan, Taiwan.
authors.forename: Chien-Cheng
authors.initials: CC
authors.lastname: Huang
authors.affiliation: Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan.|Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
authors.forename: Chien-Chin
authors.initials: CC
authors.lastname: Hsu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003404:Creatinine / Q000097:blood*; D005260:Female; D005334:Fever / Q000097:blood / Q000209:etiology / Q000401:mortality*; D015577:Geriatric Assessment; D006801:Humans; D007022:Hypotension / Q000150:complications*; D007964:Leukocytosis / Q000150:complications*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D013624:Taiwan / Q000453:epidemiology; D013921:Thrombocytopenia / Q000150:complications*
chemical_list: D003404:Creatinine
keywords: elderly; emergency; fever; geriatric; mortality; prediction