Derivation and validation of a mortality-risk index from a cohort of frail elderly patients hospitalised in medical wards via emergencies: the SAFES study

Abstract

To identify predictive factors for 2-year mortality in frail elderly patients after acute hospitalisation, and from these to derive and validate a Mortality Risk Index (MRI). A prospective cohort of elderly patients was set up in nine teaching hospitals. This cohort was randomly split up into a derivation cohort (DC) of 870 subjects and a validation cohort (VC) of 436 subjects. Data obtained from a Comprehensive Geriatric Assessment were used in a Cox model to predict 2-year mortality and to identify risk groups for mortality. A ROC analysis was performed to explore the validity of the MRI. Five factors were identified and weighted using hazard ratios to construct the MRI: age 85 or over (1 point), dependence for the ADL (1 point), delirium (2 points), malnutrition risk (2 points), and co-morbidity level (2 points for medium level, 3 points for high level). Three risk groups were identified according to the MRI. Mortality rates increased significantly across risk groups in both cohorts. In the DC, mortality rates were: 20.8% in the low-risk group, 49.6% in the medium-risk group, and 62.1% in the high-risk group. In the VC, mortality rates were respectively 21.7, 48.5, and 65.4%. The area under the ROC curve for overall score was statistically the same in the DC (0.72) as in the VC (0.71). The proposed MRI appears as a simple and easy-to-use tool developed from relevant geriatric variables. Its accuracy is good and the validation procedure gives a good stability of results.

Risk Factors and Screening Instruments to Predict Adverse Outcomes for Undifferentiated Older Emergency Department Patients: A Systematic Review and Meta‐analysis

“…[37][38][39][40][41] The outcomes assessed included mortality at 6 weeks to 2 years and institutionalization at 1 year. The variables assessed included malnutrition, age, functional limitations and dependency, presence of severe comorbidities, balance issues, number of offspring, living situation, and the presence of delirium or dementia.…”

“…Again, the Silver Code lacked sufficient prognostic accuracy to increase (LR+ ranges = 1.59 to 2.47) or decrease (LR-ranges = 0.70 to 0.88) the risk of these outcomes. Dram e et al 38 derived the "Mortality Risk Index" (Data Supplement S4) in France to evaluate for 2-year post-ED mortality among hospitalized geriatric patients. Using either of two thresholds of abnormal (≥3 or ≥5), the Mortality Risk Index lacked prognostic accuracy to increase (LR+ = 1.41 to 1.93) or decrease (LR-= 0.34 to 0.59) the 2-year mortality risk.…”

Just ask: discussing goals of care with patients in hospital with serious illness

“…[16][17][18][19][20][21][22][23][24][25][26][27] Although none of these tools is clearly superior, the system developed by Walter and colleagues 16 has been externally validated, 28,29 has good predictive accuracy (C statistic 0.79) and incorporates easily obtainable information from multiple relevant domains ( Figure 1). 16 This tool provides an estimate of 1-year mortality for groups of patients similar to a physician's specific patient.…”

Problematiche di fine vita: il ruolo della medicina interna ospedaliera

“…Nessuno degli indici presi in esame ha avuto una C-statistica di differenza tra la mortalità predetta e constatata (parametro statistico equivalente all'area sottesa alla curva ROC) superiore o uguale a 0,9, ovvero ottimale. Tredici indici avevano una C-statistica ≥0,7 (soglia sopra la quale viene considerata accettabile la capacità discriminatoria di un test): tre indici avevano C-statistiche 0,8 e 0,89 suggerendo una capacità discriminatoria molto buona; [84][85][86] dieci indici avevano C-statistiche tra 0,7 e 0,79, suggerendo una buona discriminazione [87][88][89][90][91][92][93][94][95][96][97][98][99] I relativi dati di confronto salienti sono riportati nella Tabella 27. 75,78,[100][101][102] Purtroppo nessuno degli indici valutati da Yourman, anche quando congruenti con i parametri di riferimento di qualità specificati, sembra poter essere utile nella pratica clinica del mondo reale.…”