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

Abstract

ObjectiveThe 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.DesignLongitudinal retrospective study from January to December 2014.SettingUniversity Hospital of Martinique.ParticipantsPatients aged ≥65 years, admitted to any clinical ward and who underwent reverse transcription PCR testing for CHIKV infection.OutcomeIndependent 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.ResultsOverall, 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%).ConclusionsSigns 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.

Impact of Chronic Kidney Disease on Chikungunya Virus Infection Clinical Manifestations and Outcome: Highlights during an Outbreak in Northeastern Brazil

“…7 Another recent study, with patients admitted in an intensive care unit because of CHIKV infection in India, evidenced that disease severity was mainly associated with advanced age and the presence of underlying comorbidities, and risk factors for death were high acute physiology and chronic health evaluation (APACHE) II score at admission and dialysis requirement, 24 which also evidences that kidney injury increases mortality. Cardiovascular disorders, respiratory secondary infections, sensoriomotor deficit, absence of musculoskeletal pain, history of alcoholism, digestive symptoms, and presence of confusion/ delirium were factors independently associated with death among elderly patients admitted with CHIKV infection in a university hospital in Martinique 25 and reinforce the fact that comorbidities increase the infection severity and the risk of death.…”

Long‐term survival and clinical forms in the acute phase of Chikungunya virus infection in older Caribbeans

“…The only available data concern short-term mortality [6,29] in the general population, or in-hospital mortality in the general population [7,10] or in elderly patients [13]. We reported that 9.1% of patients aged 65 years or older hospitalised with CVI died during the hospital stay [13]. Economopoulou et al [10] reported that presentation of an atypical or severe form of CVI was an independent predictor of death at the acute phase.…”

“…Data are lacking in the literature concerning mortality in the medium or long term after CVI, thus precluding comparison of our results with other studies. The only available data concern short‐term mortality in the general population, or in‐hospital mortality in the general population or in elderly patients . We reported that 9.1% of patients aged 65 years or older hospitalised with CVI died during the hospital stay .…”

“…It has been shown that older subjects more frequently present atypical or severe form than younger patients [7,10], although data remain sparse and results are sometimes contradictory [12]. We previously reported an in-hospital mortality rate of 9.1% in a population of subjects aged 65 years or older with CVI [13], vs. only 4% in the overall population of subjects admitted to hospital for CVI [7]. While data exist regarding mortality in the acute phase, there are no available data regarding the medium-to long-term mortality.…”

Clinical Forms of Chikungunya Virus Infection: The Challenge and Utility of a Consensus Definition

“…A previous study among patients aged 65 years and older reported a mortality of 9.1% in this group, and the predictors of death identified were the presence of cardiovascular, respiratory, neurological, or digestive disorders, and a history of alcoholism. 8 Therefore, these should all be considered as signs of disease severity in this population and not signs of atypical presentation. Dorléans et al 1 reported that there were 74 deaths in their study, but it would have been interesting to specify the distribution of these deaths according to the clinical forms they described.…”