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Prognostic factors of inhospital death in elderly patients: a time-to-event analysis of a cohort study in Martinique (French West Indies).

ABSTRACT: OBJECTIVE:The primary objective was to identify predictive factors of inhospital death in a population of patients aged 65 years or older hospitalised with Chikungunya virus (CHIKV) infection. The secondary aim was to develop and validate a predictive score for inhospital death based on the predictors identified. DESIGN:Longitudinal retrospective study from January to December 2014. SETTING:University Hospital of Martinique. PARTICIPANTS:Patients aged ?65 years, admitted to any clinical ward and who underwent reverse transcription PCR testing for CHIKV infection. OUTCOME:Independent predictors of inhospital death were identified using multivariable Cox regression modelling. A predictive score was created using the adjusted HRs of factors associated with inhospital death. Receiver operating characteristic curve analysis was used to determine the best cut-off value. Bootstrap analysis was used to evaluate internal validity. RESULTS:Overall, 385 patients aged ?65 years were included (average age: 80±8 years). Half were women, and 35 (9.1%) died during the hospital stay. Seven variables were found to be independently associated with inhospital death (concurrent cardiovascular disorders: HR 11.8, 95%?CI 4.5 to 30.8; concurrent respiratory infection: HR 9.6, 95%?CI 3.4 to 27.2; concurrent sensorimotor deficit: HR 7.6, 95%?CI 2.0 to 28.5; absence of musculoskeletal pain: HR 2.6, 95%?CI 1.3 to 5.3; history of alcoholism: HR 2.5, 95%?CI 1.1 to 5.9; concurrent digestive symptoms: HR 2.4, 95%?CI 1.2 to 4.9; presence of confusion or delirium: HR 2.1, 95%?CI 1.1 to 4.2). The score ranged from 0 to 25, with an average of 6±6. The area under the curve was excellent (0.90; 95%?CI 0.86 to 0.94). The best cut-off value was a score ?8 points, with a sensitivity of 91% (82%-100%) and specificity of 75% (70%-80%). CONCLUSIONS:Signs observed by the clinician during the initial examination could predict inhospital death. The score will be helpful for early management of elderly subjects presenting within 7 days of symptom onset in the context of CHIKV outbreaks.

SUBMITTER: Godaert L

PROVIDER: S-EPMC5786118 | biostudies-literature | 2018 Jan

REPOSITORIES: biostudies-literature

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Prognostic factors of inhospital death in elderly patients: a time-to-event analysis of a cohort study in Martinique (French West Indies).

Godaert Lidvine L Bartholet Seendy S Dorléans Fréderique F Najioullah Fatiha F Colas Sebastien S Fanon Jean-Luc JL Cabié André A Césaire Raymond R Dramé Moustapha M

BMJ open 20180123 1

<h4>Objective</h4>The primary objective was to identify predictive factors of inhospital death in a population of patients aged 65 years or older hospitalised with Chikungunya virus (CHIKV) infection. The secondary aim was to develop and validate a predictive score for inhospital death based on the predictors identified.<h4>Design</h4>Longitudinal retrospective study from January to December 2014.<h4>Setting</h4>University Hospital of Martinique.<h4>Participants</h4>Patients aged ≥65 years, admi ...[more]

PMID: 29362259

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Project description:BACKGROUND:The chikungunya virus (CHIKV) is a re-emerging alphavirus that can cause chronic and potentially incapacitating rheumatic musculoskeletal disorders known as chronic chikungunya arthritis (CCA). We conducted a prospective cohort study of CHIKV-infected subjects during the 2013 chikungunya outbreak in Martinique. The aim of this study was to assess the prevalence of CCA at 12 months and to search for acute phase factors significantly associated with chronicity. METHODOLOGY/PRINCIPAL FINDINGS:A total of 193 patients who tested positive for CHIKV RNA via qRT-PCR underwent clinical investigations in the acute phase (<21 days), and then 3, 6, and 12 months after inclusion. The Asian lineage was identified as the circulating genotype. A total of 167 participants were classified as either with or without CCA, and were analyzed using logistic regression models. The overall prevalence of CCA at 12 months was 52.1% (95%CI: 44.5-59.7). In univariate analysis, age (RD 9.62, 95% CI, 4.87;14.38, p<0.0001), female sex (RD 15.5, 95% CI, 1.03;30.0, p = 0.04), headache (RD 15.42, 95% CI, 0.65;30.18 p = 0.04), vertigo (RD 15.33, 95% CI, 1.47;29.19, p = 0.03), vomiting (RD 12.89, 95% CI, 1.54;24.24, p = 0.03), dyspnea (RD 13.53, 95% CI, 0.73;26.33, p = 0.04), intravenous rehydration (RD -16.12, 95% CI, -31.58; -0.66 p = 0.04) and urea (RD 0.66, 95% CI, 0.12;1.20, p = 0.02) were significantly associated with the development of CCA. For the subpopulation with data on joint involvement in the acute phase, the risk factors significantly associated with CCA were at least one 1 enthesitis (RD 16.7, 95%CI, 2.8; 30.7, p = 0.02) and at least one tenosynovitis (RD 16.8, 95% CI, 1.4-32.2, p = 0.04). CONCLUSIONS:This cohort study conducted in Martinique confirms that CCA is a common complication of acute chikungunya disease. Our analysis emphasized the importance of age and female sex for CCA occurrence, and highlighted the aggravating role of dehydration during the acute phase. Early and adequate hydration were found to reduce the risk chronic chikungunya disorders. TRIAL REGISTRATION:clinicaltrials.gov (NCT01099852).

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Prognostic factors of inhospital death in elderly patients: a time-to-event analysis of a cohort study in Martinique (French West Indies).

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Prognostic factors of inhospital death in elderly patients: a time-to-event analysis of a cohort study in Martinique (French West Indies).

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