Biomarkers, shock index and modified early warning score among older medical hospital inpatients in Nigeria

Abstract

Background: Biomarkers, shock index and modified early warning score (MEWS) are of public health importance because identification and prompt attention to them have been found to reduce mortality among older patients on admission. Objectives: A study was undertaken to determine the biomarkers, shock index and MEWS that predict mortality on admission among older medical hospital inpatients. Methods: This was a prospective study of 450 patients (≥ 60 years) on the medical wards of University College Hospital, Ibadan. Biomarkers recommended by the National Institute on Aging such as blood pressure, heart rate and pulse rate (cardiovascular functioning); cholesterol and triglycerides (metabolic processes); T-cell counts (immune system status) and weight, body mass index and waist-to-hip ratio (indicators of obesity, chronic metabolic disorders and fat deposits) were assessed. Vital signs were recorded on admission and used to calculate the shock index and MEWS. Multivariate and survival analyses were carried out at p < 0.05. Results: Baseline temperature ≥ 39.0°c (p = 0.049), pulse rate ≥ 100 beats/minute (p = 0.034), systolic blood pressure (SBP) < 120 mmHg (p = 0.048), shock index ≥1.0 (p = 0.041), age shock index (p = 0.032) and critical illness score (MEWS ≥5) p = 0.019 were significantly associated with mortality. Independent predictors of mortality on Cox regression analysis were temperature ≥ 39.0°C (HR = 3.317 [1.281-8.590]) and SBP < 120 mmHg (HR = 1.845 [1.025-3.322]). Conclusion: Prompt identification and management of fever and low blood pressure should improve the survival of older medical hospital inpatients.