Mortality of older acutely admitted medical patients after early discharge from emergency departments: a nationwide cohort study

Abstract

Background The mortality of older patients after early discharge from hospitals is sparsely described. Information on factors associated with mortality can help identify high-risk patients who may benefit from preventive interventions. The aim of this study was to examine whether demographic factors, comorbidity and admission diagnoses are predictors of 30-day mortality among acutely admitted older patients discharged within 24 h after admission. Methods All medical patients aged ≥65 years admitted acutely to Danish hospitals between 1 January 2013 and 30 June 2014 surviving a hospital stay of ≤24 h were included. Demographic factors, comorbidity, discharge diagnoses and mortality within 30 days were described using data from the Danish National Patient Registry and the Civil Registration System. Cox regression was used to estimate adjusted hazard ratios (aHR) with 95% confidence intervals (CI) for all-cause mortality. Results A total of 93,295 patients (49.4% men) with a median age of 75 years (interquartile range: 69–82 years), were included. Out of these, 2775 patients (3.0%; 95% CI 2.9–3.1%) died within 30 days after discharge. The 30-day mortality was increased in patients with age 76–85 years (aHR 1.59; 1.45–1.75) and 86+ years (aHR 3.35; 3.04–3.70), male gender (aHR 1.22; 1.11–1.33), a Charlson Comorbidity Index of 1–2 (aHR 2.15; 1.92–2.40) and 3+ (aHR 4.07; 3.65–4.54), and unmarried status (aHR 1.17; 1.08–1.27). Discharge diagnoses associated with 30-day mortality were heart failure (aHR 1.52; 1.17–1.95), respiratory failure (aHR 3.18; 2.46–4.11), dehydration (aHR 2.87; 2.51–3.29), constipation (aHR 1.31; 1.02–1.67), anemia (aHR 1.45; 1.27–1.66), pneumonia (aHR 2.24; 1.94–2.59), urinary tract infection (aHR 1.33; 1.14–1.55), dyspnea (aHR 1.57; 1.32–1.87) and suspicion of malignancy (aHR 2.06; 1.64–2.59). Conclusions Three percent had died within 30 days. High age, male gender, the comorbidity burden, unmarried status and several primary discharge diagnoses were identified as independent prognostic factors of 30-day all-cause mortality.

Predicting Short-Term Mortality in Older Patients Discharged from Acute Hospitalizations Lasting Less Than 24 Hours

“… 13 , 31 , 55 Our mortality rate is concordant with previous studies that reported 30-day mortality rates of 3%–5%, though none of these focused on early discharge. 13 , 50 , 56 …”

“… 14 , 31 A discharge diagnosis of pneumonia and a self-reported feeling of physical fatigue have also previously been shown to be independent prognostic factors of death in older patients. 13 , 33 , 49 Previous studies also found a correlation between mortality and routine laboratory tests from hospitalization, such as C-reactive protein, creatinine, sodium, hemoglobin, and glucose. 15 , 50–52 We have not been able to find studies that have examined eGFR, bilirubin, or alkaline phosphatase as prognostic factors of mortality, though these were all high-ranking variables in our model.…”

Admission Dehydration Status Portends Adverse Short-Term Mortality in Patients with Spontaneous Intracerebral Hemorrhage

“…Dehydration represents an important component in the prevention of complications/mortality in a wide variety of diseases [15,[23][24][25][26]. Dehydration, alongside fever, aspiration, and infection, is a potentially preventable complication of the course of several diseases and frequent in elderly patients [27,28].…”

The predictive value of modified soluble urokinase plasminogen activator receptor (suPAR) with National Early Warning Score (NEWS) for mortality in emergency elderly patients in Japan: a prospective pilot study

“…A statistically significant result suggests a lack of calibration. Previous studies showed that the mortality rate of elderly patients varied between the studies and we estimated it to be approximately 15% 17–19 . A sample size of 47 participants was determined based on 80% power, 0.05 significance level, five allocation ratio, and 0.8 expected AUC Data S1.…”