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Risk indices predicting the mortality rate of elderly patients under clinical follow-up.

ABSTRACT: INTRODUCTION:Mortality in the elderly population tends to be higher than in other age groups, but risk factor indices predicting mortality are not fully known.This large-scale clinical study aimed to identify risk factors affecting mortality, with particular focus on age and hospitalisation, and to demonstrate their effectiveness. MATERIAL AND METHODS:Patients with a clinical follow-up at 29 May?s State Hospital from July 2015 to January 2020 were retrospectively analysed. The missing or ambiguous records excluded. Age, gender, hospital length of stay, co-morbidity, consultation request and infectious diseases were investigated for their effectiveness on mortality. Through with the binary logistic regression analysis final results were obtained. Primary outcomes were factors affecting overall hospital mortality in elderly population. RESULTS:A total of 11430 patients,39.9% of whom were aged?65years. Risk factors for hospital mortality were identified in the elderly population; Consultation request and hospital length of stay of?4days showed the following findings:Adjusted odds ratio(AOR)[95% confidence limit(CI)]of[1.95(1.53,2.49)(P<0.001) and 2.49(1.90,3.26)(P<0.001)],respectively. CONCLUSION:Among the predictive indices determined for mortality, the most important predictive risk factor in the elderly group is the duration of hospital stay, whereas compared to the young age group, being age of 65years old stands out in terms of risk.

SUBMITTER: Dulger D

PROVIDER: S-EPMC7379462 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Risk indices that predict in-hospital mortality of elderly patients

Dülger Dilek D Albuz Özgür Ö

Turkish journal of medical sciences 20200623 4

<h4>Background/aim</h4>Mortality in the elderly population tends to be higher than in all other age groups; the risk factors that predict mortality among those in this age cohort are not fully understood. This large-scale clinical study aimed to identify effective risk factors that predict mortality in the elderly population with a particular focus on age and hospitalization status.<h4>Material and methods</h4>We retrospectively analyzed outcomes from patients with clinical follow-up between Jul ...[more]

PMID: 32490649

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Project description:PurposeNormalized emphysema score is a protocol-robust CT biomarker of mortality. We aimed to improve mortality prediction by including the emphysema score progression rate-its change over time-into the models.Method and materialsCT scans from 6000 National Lung Screening Trial CT arm participants were included. Of these, 1810 died (445 lung cancer-specific). The remaining 4190 survivors were sampled with replacement up to 24432 to approximate the full cohort. Three overlapping subcohorts were formed which required participants to have images from specific screening rounds. Emphysema scores were obtained after resampling, normalization, and bullae cluster analysis of the original images. Base models contained solely the latest emphysema score. Progression models included emphysema score progression rate. Models were adjusted by including baseline age, sex, BMI, smoking status, smoking intensity, smoking duration, and previous COPD diagnosis. Cox proportional hazard models predicting all-cause and lung cancer mortality were compared by calculating the area under the curve per year follow-up.ResultsIn the subcohort of participants with baseline and first annual follow-up scans, the analysis was performed on 4940 participants (23227 after resampling). Area under the curve for all-cause mortality predictions of the base and progression models 6 years after baseline were 0.564 (0.564 to 0.565) and 0.569 (0.568 to 0.569) when unadjusted, and 0.704 (0.703 to 0.704) to 0.705 (0.704 to 0.705) when adjusted. The respective performances predicting lung cancer mortality were 0.638 (0.637 to 0.639) and 0.643 (0.642 to 0.644) when unadjusted, and 0.724 (0.723 to 0.725) and 0.725 (0.725 to 0.726) when adjusted.ConclusionIncluding emphysema score progression rate into risk models shows no clinically relevant improvement in mortality risk prediction. This is because scan normalization does not adjust for an overall change in lung density. Adjusting for changes in smoking behavior is likely required to make this a clinically useful measure of emphysema progression.

Project description:BackgroundThe natural history of patients commencing dialysis in East Yorkshire is not well characterised and there is little convincing evidence which has studied the impact of potential factors prior to commencement of renal replacement therapy (RRT) at predicting mortality during dialysis. The aim of this study was to examine the previously published 5-year data on end stage renal disease and co-morbid risk factors for mortality at 10 years.MethodsAn observational cohort study of subjects commencing dialysis in 2001/02 in East Yorkshire with a mean follow up from dialysis initiation of 8.8 years. Predictors of mortality were determined by univariate, multivariate analysis and survival via Kaplan-Meier analysis. Assessment of the utility of the Tangri risk calculator was carried out in addition to slope change in eGFR prior to dialysis commencement.ResultsBaseline characteristics and the preferred mode of dialysis remained concordant with the original trial. The mortality rate at the end of the study period was 60% (56/94) with 30% (29) of patients having been transplanted. Highlighted in the 5 year data a significant proportion of mortality was made up of vascular disease and sepsis (71%) but this proportion had decreased (57%) by 10 years. Cardiac disease was the commonest cause of death but notably in 18% of patients, death was related to dialysis or withdrawal of treatment. Vascular disease and diabetes remained independent risk factors and predicative of mortality. Calcium-phosphate product which was associated in the early years with mortality was not in later years. Use of the risk calculator was predictive of commencement of RRT but not mortality but slope change in eGFR was predictive of mortality.ConclusionsAlthough diabetes and vascular disease remained predictive of mortality, interestingly calcium-phosphate levels are no longer significant and may be a more specific predictor of early cardiac mortality. Slope eGFR changes prior to RRT are a predictor of mortality. We speculate that aggressive management of cardiac risk factors in addition to early transplantation may be key to influencing the impact of survival in this cohort in addition to possible measures to delay renal progression.

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Risk indices predicting the mortality rate of elderly patients under clinical follow-up.

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Risk indices that predict in-hospital mortality of elderly patients

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