Morbidity Measures Predicting Mortality in Inpatients: A Systematic Review

Soh, Cheng Hwee; Hassan, Syed Wajih Ul; Sacre, Julian W.; Maier, Andrea B.

doi:10.1016/j.jamda.2019.12.001

Cited by 39 publications

(43 citation statements)

References 60 publications

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“…The Charlson Comorbidity Index has several strengths in its use as a summary measure of comorbid disease. First, it has been widely demonstrated to be associated with health outcomes in general [13, 14] and specifically in COVID-19 [15]. Second, it can be assessed using EHR data, administrative data, or direct patient interview [13, 16].…”

Section: Discussionmentioning

confidence: 99%

Accuracy of the Veterans Health Administration COVID-19 (VACO) Index for predicting short-term mortality among 1,307 Yale New Haven Hospital inpatients and 427,224 Medicare patients

King

Yoon

Bredl³

et al. 2021

Preprint

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BackgroundThe Veterans Health Administration COVID-19 (VACO) Index incorporates age, sex, and pre-existing comorbidity diagnoses readily available in the electronic health record (EHR) to predict 30-day all-cause mortality in both inpatients and outpatients infected with SARS-CoV-2. We examined the performance of the Index using data from Yale New Haven Hospital (YNHH) and national Medicare data overall, over time, and within important patient subgroups.Methods and findingsWith measures and weights previously derived and validated in a national Veterans Healthcare Administration (VA) sample, we evaluated the accuracy of the VACO Index for estimating inpatient (YNHH) and both inpatient and outpatient mortality (Medicare) using area under the receiver operating characteristic curve (AUC) and comparisons of predicted versus observed mortality by decile (calibration plots). The VACO Index demonstrated similar discrimination and calibration in both settings, over time, and among important patient subgroups including women, Blacks, Hispanics, Asians, and Native Americans. In sensitivity analyses, we allowed component variables to be re-weighted in the validation datasets and found that weights were largely consistent with those determined in VA data. Supplementing the VACO Index with body mass index and race/ethnicity had no effect on discrimination.ConclusionAmong COVID-19 positive individuals, the VACO Index accurately estimates risk of short-term mortality among a wide variety of patients. While it modestly over-estimates risk in recent intervals, the Index consistently identifies those at greatest relative risk. The VACO Index could identify individuals who should continue practicing social distancing, help determine who should be prioritized for vaccination, and among outpatients who test positive for SARS-CoV-2, indicate who should receive greater clinical attention or monoclonal antibodies.

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Section: Discussionmentioning

confidence: 99%

Accuracy of the Veterans Health Administration COVID-19 (VACO) Index for predicting short-term mortality among 1,307 Yale New Haven Hospital inpatients and 427,224 Medicare patients

King

Yoon

Bredl³

et al. 2021

Preprint

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“…We calculated the Charlson Comorbidity Index (CCI) based on medical history and medication used [16]. A score at or above 5 points was considered abnormal [17, 18]. As part of the CCI, we used renal function to score for the presence of moderate to CKD.…”

Section: Methodsmentioning

confidence: 99%

Mortality Risk and Its Association with Geriatric Domain Deficits in Older Outpatients: The Amsterdam Ageing Cohort

et al. 2021

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Introduction: In older patients, life expectancy is determined by a complex interaction of multiple geriatric domains. A comprehensive geriatric assessment (CGA) captures different geriatric domains. Yet, if and how components of the CGA are related to mortality in an outpatient geriatric setting is unknown. In the Amsterdam Ageing Cohort, we therefore studied distribution and accumulation of geriatric domain deficits in relation to mortality. Methods: All patients received a CGA as part of standard care, independent of referral reason. We summarized deficits on the CGA, using predefined cutoffs, in 5 geriatric domains: somatic, mental, nutritional, physical, and social domain. Information on mortality was obtained from the Dutch municipal register. We used age- and sex-adjusted Cox proportional hazards analyses to relate the separate domains and accumulation of impaired domains to overall mortality. Results: From the 1,055 geriatric outpatients (53% female; age 79 ± 7 years), 172 patients (16%) had died after 1.7 ± 1.1 years. In 626 patients (59%), 3 or more domains were impaired. All domains were independently associated with mortality, with the highest hazard for the somatic domain (HR 3.7 [1.7–8.0]) and the lowest hazard for the mental domain (HR 1.5 [1.1–12.0]). In addition, accumulation of impaired domains showed a gradually increased mortality risk, ranging from HR 2.2 (0.8–6.1) for 2 domains to HR 9.6 (3.7–24.7) for all 5 domains impaired. Conclusions: This study provides evidence that impairment in multiple geriatric domains is highly prevalent and independently and cumulatively associated with mortality in an outpatient geriatric setting.

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“…The presence and severity of multimorbidity influences aspects of medical care from diagnosis to treatment decision-making, deliverability, and tolerability. Higher multimorbidity scores predict greater mortality following discharge from internal and geriatric medicine wards, particularly over longer follow-up periods [5]. However, to our knowledge, there are currently no data describing their relationship with mortality in geriatric rehabilitation patients.…”

Section: Introductionmentioning

confidence: 94%

“…Multimorbidity, the concurrent presence of two or more medical conditions in an individual [3], increases in prevalence with age in both the general [3] and oncological populations [4]. It may be measured using a number of validated assessment tools, the Charlson Comorbidity Index (CCI) and Cumulative Illness Rating Scale-Geriatric (CIRS-G) version being two of the most commonly utilized [5].…”

Section: Introductionmentioning

confidence: 99%

The association of comorbidity measures and mortality in geriatric rehabilitation inpatients by cancer status: RESORT

Chan

Maddison

Reijnierse

et al. 2021

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Background Multimorbidity is highly prevalent in older adults, both those with and without cancer, and is associated with an increased risk of mortality. The aim of this study was to investigate if multimorbidity measures in geriatric rehabilitation inpatients differ in their association with mortality, dependent on a diagnosis of cancer. Methods REStORing health of acutely unwell adulTs (RESORT) is an ongoing longitudinal inception cohort of geriatric rehabilitation inpatients. Comorbidity was measured at admission using the Charlson Comorbidity Index (CCI), age-adjusted CCI (CCI-A), Cumulative Illness Rating Scale–Geriatrics (CIRS-G) and the CIRS-G severity index. Patients were allocated to a cancer status group (no cancer, history of cancer, or active cancer). The association of comorbidity indices with mortality was analyzed using Cox regression analyses. Results Of the 693 patients (mean age 82.2 ± 7.5 years), 523 (75.4%) had no history of cancer, 96 (13.9%) past cancer, and 74 (10.7%) active cancer. Three months post-discharge, patients with active cancer had a higher mortality risk compared to patients with no cancer (HR = 3.57, 95% CI 2.03–6.23). CCI and CCI-A scores were significantly associated with higher mortality risk in all cancer status groups. Conclusion In geriatric rehabilitation patients, incremental CCI and CCI-A scores were associated with higher mortality in all three cancer status groups. However, patients with active cancer had a significantly higher 3-month mortality compared to those with no or past cancer, and this is likely determined by the advanced nature of the malignancies in this group.

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Morbidity Measures Predicting Mortality in Inpatients: A Systematic Review

Cited by 39 publications

References 60 publications

Accuracy of the Veterans Health Administration COVID-19 (VACO) Index for predicting short-term mortality among 1,307 Yale New Haven Hospital inpatients and 427,224 Medicare patients

Accuracy of the Veterans Health Administration COVID-19 (VACO) Index for predicting short-term mortality among 1,307 Yale New Haven Hospital inpatients and 427,224 Medicare patients

Mortality Risk and Its Association with Geriatric Domain Deficits in Older Outpatients: The Amsterdam Ageing Cohort

The association of comorbidity measures and mortality in geriatric rehabilitation inpatients by cancer status: RESORT

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