Predictors of short- and long-term mortality among acutely admitted older patients: role of inflammation and frailty

Abstract

Background Frailty, demographic and clinical variables linked to incident diseases (e.g., dehydration, inflammation) contribute to poor outcomes in older patients acutely hospitalized. Their predictivity on short-, intermediate- and long-term mortality in a comprehensive model has been scarcely investigated. Aims To test the performance of a predictive tool considering frailty and inflammation as well as age, sex and impaired hydration status on 1-year mortality in acutely admitted older patients. Methods Retrospective observational study including 529 medical patients (age 84.6 ± 7.3 years). At hospital admission, frailty was assessed by the Multidimensional Prognostic Index (MPI). The Glasgow Prognostic Score (GPS) was used to grade systemic inflammation. Serum osmolarity was calculated to assess hydration. Results After adjusting for age, sex, GPS and osmolarity, the severe-risk MPI was a strong predictor for 1-year mortality (OR 4.133; 95% CI 2.273–7.516; p < 0.001). Age > 85 years, male sex, GPS-2 and serum osmolarity > 300 mOsm/L were independent predictors of mortality in the same multivariable model. The MPI alone showed a moderate discrimination power (AUC 0.678; 95% CI 0.628–0.729; p < 0.001) on 1-year mortality, which increased by 12.5% after the addition of the above predictors in the fully adjusted regression model (AUC 0.763; 95% CI 0.719–0.807; p < 0.001). The severe-risk MPI adjusted for the same factors was also an independent predictor of mortality after 60 and 180 days since hospital admission. Discussion Inflammation and impaired hydration are potentially modifiable risk factors for severe outcomes in older acutely hospitalized patients. A model combining GPS, age, gender, and plasma osmolarity improved the accuracy of MPI at admission in predicting long-term mortality.

Postoperative Dehydration Is Associated with Frailty and Decreased Survival in Older Patients with Hip Fracture

“…In this study, preoperative dehydration was not related to frailty measured by the Multidimensional Prognostic Index which includes information on nutritional, functional, cognitive and social status as well as on polypharmacy and comorbidities [24]. This is in line with previous data from our group in a different cohort of older, acutely hospitalized patients, showing an independent contribution of dehydration and frailty to increased mortality [31].…”

“…Postoperative HD was also an independent risk factor for increased hospital LOS along with severity of disease as defined by the Glasgow prognostic score. Based on previous literature [24,31,32], the selected cut offs for moderately-to-severely decreased renal function, GPS poor prognosis and MPI severe risk were, respectively, an eGFR <60 mL/min/1.73 m 2 , a GPS score of 2 and a MPI value of 0.67-1.00. These cut offs have been shown to correlate with adverse clinical outcomes, included prolonged LOS and in-creased mortality.…”

The relationship between frailty, nutritional status, co-morbidity, CT-body composition and systemic inflammation in patients with COVID-19

“…While the basis of the relationship between frailty and clinical outcomes remains unclear, a recent review by Hussien et al hypothesised that frail patients have a pre-existing immuno-pathological base, that puts them at a higher risk of mortality if they contract COVID-19 [ 19 ]. Indeed, a chronic inflammatory response and immunosenescence is recognised with advanced age [ 34 , 35 ]. In the present study, systemic inflammation, as measured by NLR, was associated with frailty and 30-day mortality.…”

“…Therefore, it may be speculated that the prognostic value and treatment of the systemic inflammatory response will be greatest in older, frail patients with COVID-19. However, few studies to date have examined the relationship between frailty and systemic inflammation [ 35 ]. Therefore, it remains unclear if relationship between frailty and systemic inflammation in patients with COVID-19 is independent of age.…”

Prediction of Mortality in Older Hospitalized Patients after Discharge as Determined by Comprehensive Geriatric Assessment

“…Additionally, hospital admission for the older patient is frequently associated with physical decline and mortality after discharge [4,5]. Previous research has reported that an increased age, functional disability, cognitive impairment at admission, multimorbidity, and poor nutritional status all predict a worsening of physical function after discharge [6], and later mortality [7], either in the short-term (e.g., within 1 or 3 months after discharge) [7,8] or long-term (beyond 3 months after discharge) [9,10]. Knowing these prognostic factors which surrounding different survival time periods are particularly important for old and frail patients who have approached the end of their lives, and this information will help towards providing individual care planning.…”