HOSPITAL Score and LACE Index to Predict Mortality in Multimorbid Older Patients

Abstract

Background Estimating life expectancy of older adults informs whether to pursue future investigation and therapy. Several models to predict mortality have been developed but often require data not immediately available during routine clinical care. The HOSPITAL score and the LACE index were previously validated to predict 30-day readmissions but may also help to assess mortality risk. We assessed their performance to predict 1-year and 30-day mortality in hospitalized older multimorbid patients with polypharmacy. Methods We calculated the HOSPITAL score and LACE index in patients from the OPERAM (OPtimising thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly) trial (patients aged ≥ 70 years with multimorbidity and polypharmacy, admitted to hospital across four European countries in 2016-2018). Our primary and secondary outcomes were 1-year and 30-day mortality. We assessed the overall accuracy (scaled Brier score, the lower the better), calibration (predicted/observed proportions), and discrimination (C-statistic) of the models. Results Within 1 year, 375/1879 (20.0%) patients had died, including 94 deaths within 30 days. The overall accuracy was good and similar for both models (scaled Brier score 0.01-0.08). The C-statistics were identical for both models (0.69 for 1-year mortality, p = 0.81; 0.66 for 30-day mortality, p = 0.94). Calibration showed well-matching predicted/observed proportions. ConclusionThe HOSPITAL score and LACE index showed similar performance to predict 1-year and 30-day mortality in older multimorbid patients with polypharmacy. Their overall accuracy was good, their discrimination low to moderate, and the calibration good. These simple tools may help predict older multimorbid patients' mortality after hospitalization, which may inform post-hospitalization intensity of care.

Factors Affecting the Effectiveness of Discharge Planning Implementation: A Case-Control Cohort Study

“…This model was developed to identify the risk of potentially avoidable 30-day readmission in medical patients before discharge (Donzé et al, 2013). Both the LACE index and HOSPITAL score models have been used effectively to identify patients at a high risk of readmission (Su et al, 2020) and to predict mortality in multimorbid older patients (Aubert et al, 2022). However, the characteristics of these high-risk patients are not addressed in these models.…”

Multimorbidity, consisting of a combination of chronic diseases and geriatric syndromes, predicts the risk of difficulty in discharge home in older patients admitted to acute care hospital

“…Multimorbidity, consisting of chronic diseases combined with instrumental ADL and basic ADL, has been reported to predict | 303 mortality at 30 days and 1 year after admission. 21 Individuals with low BMI, number of drugs, and high Charlson comorbidity index have also been reported to have increased mortality at 1 year. 22 In patients admitted for exacerbation of chronic diseases, multimorbidity of osteoarticular and psychogeriatric patterns was accompanied by 7.76 and 8.16 geriatric syndromes, respectively, indicating the need to focus not only on chronic diseases but also on geriatric syndromes.…”

“…These results suggest that geriatric syndromes, including functional impairment (instrumental ADL and basic ADL), may have a greater impact on discharge outcomes in older patients. Multimorbidity, consisting of chronic diseases combined with instrumental ADL and basic ADL, has been reported to predict mortality at 30 days and 1 year after admission 21 . Individuals with low BMI, number of drugs, and high Charlson comorbidity index have also been reported to have increased mortality at 1 year 22 .…”

The Early HOSPITAL Score to Predict 30-Day Readmission Soon After Hospitalization: a Prospective Multicenter Study

“…Because not all of the hospitals had a specific oncology division, the variable “discharge from an O ncology service” (letter “O”) was replaced by “active O ncologic diagnosis on admission or during hospitalization,” i.e., in the past 5 years, including metastatic and non-metastatic solid tumors and hematologic malignancies. 13 , 15 , 16 The following procedures (letter “P”) were taken into account in the original version for the HOSPITAL score: coronary angiography, angioplasty, thromboaspiration, stenting, pacemaker implantation, transesophageal echocardiography, esogastroduodenoscopy, endoscopic retrograde cholangio-pancreatography, coloscopy, bronchoscopy, biopsy, thoracocentesis, lumbal puncture, paracentesis, chemotherapy, radiotherapy, continuous pressure ventilation, intubation, transfusion (blood or platelets), graft, dialysis, operation, suture, electro-neuromyography, joint aspiration, cystoscopy, bone marrow aspiration/biopsy, magnetic resonance imaging, computer tomography, angiography, positron emission tomography, scintigraphy. 1 We collected the variables “ I ndex admission T ype” (letter “I” and “T”) and “number of hospital A dmission(s) during the previous year” (letter “A”) as in the original study.…”

“…We adapted the cutoff for the length of stay (letter “L”) to the median length of stay in Switzerland (8 days instead of 5 days for the USA), as previously done. 13 , 16 The simplified version of the HOSPITAL score includes six variables with the number of procedures being left out (Table 1 ). The three versions of the HOSPITAL score were compared: the original HOSPITAL score, the simplified HOSPITAL score, and the early HOSPITAL score (simplified score with lab at admission).…”