Prediction value of the LACE index to identify older adults at high risk for all-cause mortality in South Korea: a nationwide population-based study

Abstract

Background As a tool to predict early hospital readmission, little is known about the association between LACE index and all-cause mortality in older adults. We aimed to validate the LACE index to predict all-cause mortality in older adults and also analyzed the LACE index outcome of all-cause mortality depending on the disease and age of the participants. Methods We used the National Health Insurance Service (NHIS) cohort, a nationwide claims database of Koreans. We enrolled 7491 patients who were hospitalized at least once between 2003 and 2004, aged ≥65 years as of the year of discharge, and subsequently followed-up until 2015. We estimated the LACE index using the NHI database. The Cox proportional hazards model was used to estimate the hazard ratio (HR) for all-cause mortality. Furthermore, we investigated all-cause mortality according to age and underlying disease when the LACE index was ≥10 and < 10, respectively. Results In populations over 65 years of age, patients with LACE index ≥10 had significantly higher risks of all-cause mortality than in those with LACE index < 10. (HR, 1.44; 95% confidence interval, 1.35–1.54). For those patients aged 65–74 years, the HR of all-cause mortality was found to be higher in patients with LACE index≥10 than in those with LACE index < 10 in almost all the diseases except CRF and mental illnesses. And those patients aged ≥75 years, the HR of all- cause mortality was found to be higher in patients with LACE index ≥10 than in those with LACE index < 10 in the diseases of pneumonia and MACE. Conclusion This is the first study to validate the predictive power of the LACE index to identify older adults at high risk for all-cause mortality using nationwide cohort data. Our findings have policy implications for selecting or managing patients who need post-discharge management.

High LACE index scores are associated with disproportionate excess deaths in hospital amongst patients with COVID-19

“…The LACE index has been shown extensively to relate to a number of outcomes including frequent early readmissions, and mortality whether in-hospital or after a discharge from hospital, in different study populations and admitted with a variety of non-COVID-19 medical conditions [ 10 – 15 ]. Unlike existing binary variables used to relate COVID-19 outcomes with variables, such as gender, ethnicity, obesity and learning difficulties, the LACE index has a wide range of scale (0–19 points).…”

“…The LACE index (Length of stay; Acuity of admission; Charlson co-morbidity index; Emergency department visits) scoring tool has been developed and validated to predict health outcomes, such as short-term mortality, readmission after a hospital discharge [ 9 ] and in-hospital mortality [ 10 , 11 ]. This standardised index has been used widely in research and clinical practice for a number of years in different populations and conditions [ 10 – 15 ]. In this study, we hypothesised that patients with high LACE index scores might be at increased risk of death from COVID-19 infection.…”