title: Predicting mortality in acutely hospitalized older patients: a retrospective cohort study.
abstract: Acutely hospitalized older patients have an increased risk of mortality, but at the moment of presentation this risk is difficult to assess. Early identification of patients at high risk might increase the awareness of the physician, and enable tailored decision-making. Existing screening instruments mainly use either geriatric factors or severity of disease for prognostication. Predictive performance of these instruments is moderate, which hampers successive interventions. We conducted a retrospective cohort study among all patients aged 70 years and over who were acutely hospitalized in the Acute Medical Unit of the Leiden University Medical Center, the Netherlands in 2012. We developed a prediction model for 90-day mortality that combines vital signs and laboratory test results reflecting severity of disease with geriatric factors, represented by comorbidities and number of medications. Among 517 patients, 94 patients (18.2 %) died within 90 days after admission. Six predictors of mortality were included in a model for mortality: oxygen saturation, Charlson comorbidity index, thrombocytes, urea, C-reactive protein and non-fasting glucose. The prediction model performs satisfactorily with an 0.738 (0.667-0.798). Using this model, 53 % of the patients in the highest risk decile (N = 51) were deceased within 90 days. In conclusion, we are able to predict 90-day mortality in acutely hospitalized older patients using a model with directly available clinical data describing disease severity and geriatric factors. After further validation, such a model might be used in clinical decision making in older patients.
authors.affiliation: Department of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands. j.de_gelder@lumc.nl.
authors.forename: Jelle
authors.initials: J
authors.lastname: de Gelder
authors.affiliation: Department of Emergency Medicine, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Jacinta A
authors.initials: JA
authors.lastname: Lucke
authors.affiliation: Department of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
authors.forename: Noor
authors.initials: N
authors.lastname: Heim
authors.affiliation: Department of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
authors.forename: Antonius J M
authors.initials: AJ
authors.lastname: de Craen
authors.affiliation: Department of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
authors.forename: Shantaily D
authors.initials: SD
authors.lastname: Lourens
authors.affiliation: Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Ewout W
authors.initials: EW
authors.lastname: Steyerberg
authors.affiliation: Department of Emergency Medicine, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Bas
authors.initials: B
authors.lastname: de Groot
authors.affiliation: Department of Internal Medicine, Section Acute Care, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Anne J
authors.initials: AJ
authors.lastname: Fogteloo
authors.affiliation: Department of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: Blauw
authors.affiliation: Department of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.|Institute of Evidence-Based Medicine in Old Age, IEMO, Leiden, The Netherlands.
authors.forename: Simon P
authors.initials: SP
authors.lastname: Mooijaart
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000032:analysis; D015897:Comorbidity; D003955:Diagnostic Tests, Routine; D005260:Female; D015577:Geriatric Assessment; D017052:Hospital Mortality; D006801:Humans; D009426:Netherlands / Q000453:epidemiology; D019338:Polypharmacy; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D055986:Vital Signs
chemical_list: D015415:Biomarkers
keywords: Acute hospitalization; Elderly; Mortality; Older adults; Prediction
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