Document Detail


Predicting early mortality among elderly patients hospitalised in medical wards via emergency department: the SAFES cohort study.
MedLine Citation:
PMID:  18810299     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The aim of the study was, by early identification of deleterious prognostic factors that are open to remediation, to be in a position to assign elderly patients to different mortality risk groups to improve management.
DESIGN: Prospective multicentre cohort.
SETTING: Nine French teaching hospitals.
PARTICIPANTS: One thousand three hundred and six (1 306) patients aged 75 and over, hospitalised after having passed through Emergency Department (ED).
MEASUREMENTS: Patients were assessed using Comprehensive Geriatric Assessment (CGA) tools. A Cox survival analysis was performed to identify prognostic variables for six-week mortality. Receiver Operating Characteristics analysis was used to study the discriminant power of the model. A mortality risk score is proposed to define three risk groups for six-week mortality.
RESULTS: Crude mortality rate after a six week follow-up was 10.6% (n=135). Prognostic factors identified were: malnutrition risk (HR=2.1; 95% CI: 1.1-3.8; p=.02), delirium (HR=1.7; 95% CI: 1.2-2.5; p=.006), and dependency: moderate dependency (HR=4.9; 95% CI: 1.5-16.5; p=.01) or severe dependency (HR=10.3; 95% CI: 3.2-33.1; p < .001). The discriminant power of the model was good: the c-statistic representing the area under the curve was 0.71 (95% IC: 0.67 - 0.75; p < .001). The six-week mortality rate increased significantly (p < .001) across the three risk groups: 1.1% (n=269; 95% CI=0.5-1.7) in the lowest risk group, 11.1% (n=854; 95% CI=9.4-12.9) in the intermediate risk group, and 22.4% (n=125; 95% CI=20.1-24.7) in the highest risk group.
CONCLUSIONS: A simple score has been calculated (using only three variables from the CGA) and a practical schedule proposed to characterise patients according to the degree of mortality risk. Each of these three variables (malnutrition risk, delirium, and dependency) identified as independent prognostic factors can lead to a targeted therapeutic option to prevent early mortality.
Authors:
M Drame; N Jovenin; J L Novella; P O Lang; D Somme; I Laniece; T Voisin; P Blanc; P Couturier; J B Gauvain; F Blanchard; D Jolly
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The journal of nutrition, health & aging     Volume:  12     ISSN:  1279-7707     ISO Abbreviation:  J Nutr Health Aging     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-09-23     Completed Date:  2009-01-29     Revised Date:  2014-07-30    
Medline Journal Info:
Nlm Unique ID:  100893366     Medline TA:  J Nutr Health Aging     Country:  France    
Other Details:
Languages:  eng     Pagination:  599-604     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Area Under Curve
Cohort Studies
Comorbidity
Delirium / epidemiology*
Emergency Service, Hospital / statistics & numerical data*
Female
France / epidemiology
Geriatric Assessment*
Hospital Mortality*
Humans
Male
Malnutrition / epidemiology*
Predictive Value of Tests
Prognosis
Proportional Hazards Models
Prospective Studies
ROC Curve
Risk Assessment*
Risk Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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