The effect of comorbidity and age on hospital mortality and length of stay in patients with sepsis

Yang, Yong; Yang, Kok Soong; Hsann, Yin Maw; Lim, Vincent; Ong, Biauw Chi

doi:10.1016/j.jcrc.2009.09.001

Cited by 123 publications

(112 citation statements)

References 30 publications

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“…Age has been shown to play an important role in infection associated mortality in many studies. 12,14,21 This was also shown in our study in that the mortality rate for those aged >85 was 1.9-fold higher than for those aged between 75 and 84 years. However, its significance decreased when other confounders were included, which is consistent with previous reports.…”

Section: Discussionsupporting

confidence: 86%

A scoring system to predict in-hospital death in oldest-old patients with infections in Taiwan

Chen

Hwang

Tjung

et al. 2012

Journal of Clinical Gerontology and Geriatrics

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a b s t r a c tBackground: The elderly population has the highest number of in-patient claims accounting for over 40% of in-patient medical expenses in Taiwan, and infectious diseases are one of the most common causes of hospitalization in elderly patients. The aims of the study were to identify independent predictors of mortality, and to develop a simple scoring system for use in a busy clinical medical setting. Methods: All patients aged 75 years and older presenting to our emergency department or outpatient clinics who were subsequently admitted due to infections between March and July 2009 were enrolled. Results: A total of 981 patients were included, and the mortality rate was 9.2%. Logistic regression revealed seven independent predictors of mortality [odds ratio (95% confidence interval)]: albumin <3 g/ dL [3.72 (1.97e7.00)], creatinine >1.5 mg/dL [2.94 (1.69e5.09)], total dependence on admission [1.64 (1.11e2.43)], systolic blood pressure <100 mmHg [4.46 (2.02e9.84)], white blood cell count !10 or 4 Â 10 9 /L [2.23 (1.23e4.04)], total bilirubin >1.2 mg/dL [2.37 (1.31e4.31)], and malignancy history [2.73 (1. 4e5.30)]. These were given weighting by discriminant analysis and used to create a receiver operating curve with an area under the curve of 0.820. The model was simplified and each variable was assigned scores of 3 or 4 to form an index predicting in-hospital mortality. Mortality increased with score: 0.9% for score <5; 6.9% for 6 to 11; 21.4% for 12 to15, 53.7% for 16 to 19, and all three subjects whose score was >19 died during hospitalization. Conclusion: Our scoring system derived from seven readily available variables including activity level, malignancy history, systolic blood pressure, and a small number of laboratory parameters predicted inhospital mortality in oldest-old patients with infections. This system may allow for the identification of high-risk patients soon after admission.

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Section: Discussionsupporting

confidence: 86%

A scoring system to predict in-hospital death in oldest-old patients with infections in Taiwan

Chen

Hwang

Tjung

et al. 2012

Journal of Clinical Gerontology and Geriatrics

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“…It has been validated in predicting in-hospital mortality when applied to ICD-10 data [14] and shown to be a useful tool in predicting outcome in various disease states. Yang et al [15] found the CCI score (odds ratio 11.8; CCI ≥5 versus 0) to be a significant independent predictor of hospital mortality in patients with sepsis. In patients with heart failure, an increasing CCI score was associated with increased long-term mortality (HR 1.26, 95% CI 1.19-1.35; p < 0.0001) [16].…”

Section: Discussionmentioning

confidence: 99%

Prognostic Impact of the Charlson Comorbidity Index on Mortality following Acute Pulmonary Embolism

Chow

Yong

et al. 2012

Respiration

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Objectives: It was the aim of this study to determine the prognostic significance of the Charlson Comorbidity Index (CCI) following acute pulmonary embolism (PE) and assess the prognosis of patients without comorbidities (defined as a CCI score of 0). Methods: Outcomes of 1,023 consecutive patients admitted with confirmed PE were tracked after a median of 3.7 years (25-75th interquartile range 1.5-6.1 years). All were assigned a non-age-adjusted CCI score. Results: The median CCI score was 1.0 (interquartile range 0.0-3.0). Three hundred and fifty-one (34%) patients had a CCI score of 0. Only 1 (0.3%) of 31 in-hospital deaths occurred in patients with a CCI score of 0. Long-term mortality for these patients was similar to the population-derived age- and sex-matched mortality rate, and was significantly better than for those with a CCI score ≥1 (12.5 vs. 47.5%; p < 0.0001 adjusted for age and sex). In multivariate analysis, CCI (per 1-score increase) independently predicted in-hospital (hazard ratio 1.27, 95% confidence interval 1.09-1.49; p = 0.003) and post-discharge (hazard ratio 1.35, 95% confidence interval 1.29-1.42; p < 0.0001) death. The c statistics for the multivariate prediction models for in-hospital (incorporating CCI score and serum sodium level) and post-discharge death (age, CCI score, hyperlipidemia, serum sodium and hemoglobin) were 0.738 and 0.788, respectively (both p < 0.0001). Conclusion: The CCI can be incorporated into risk models, with good discriminatory power, for predicting in-hospital and long-term outcomes following acute PE. Patients with a CCI score of 0 have a favorable long-term outcome following acute PE.

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“…Sepsis was defined 1,3 as the presence of any of the ICD-9-AM codes listed in Table 1. In previous validation studies, 1,12 this method had positive predictive values of 88.7% to 99.8% for identifying true cases of sepsis.…”

Section: Case Definitionmentioning

confidence: 99%

“…3 Sepsis often occurs in patients with diabetes mellitus, and diabetes mellitus is associated with marked morbidity and mortality.…”

Section: Case Definitionmentioning

confidence: 99%

Respiratory Dysfunction in Patients With Sepsis: Protective Effect of Diabetes Mellitus

Yang

Salam

Ong

et al. 2011

American Journal of Critical Care

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Background Sepsis is a common complication in patients with diabetes mellitus. In a Western population, risk of respiratory dysfunction was lower in diabetic patients with sepsis. Objective To compare organ dysfunction, particularly respiratory dysfunction, between sepsis patients with and without diabetes mellitus in an Asian population. Method Hospital discharge data were collected for the period 2004 through 2008. Patients with sepsis, diabetes mellitus, and organ dysfunction were identified by using the International Statistical Classification of Diseases and Related Health Problems, 9th Revision, Australian Modification codes. Results Of the 383 238 patients hospitalized during the 5 years, 2943 of the 9221 who had sepsis also had diabetes (31.9%).The most common organ dysfunctions in patients with sepsis were renal (31.5%), cardiovascular (19.2%), and respiratory (10.9%). Among patients with sepsis, respiratory dysfunction was less likely in patients with diabetes (9.4%) than in those without (11.6%; P = .002), but renal dysfunction was more likely in patients with diabetes (46.5%) than in those without (24.4%; P < .001). However, only 27.6% of patients with diabetes had a respiratory source of sepsis compared with 33.4% in patients without diabetes (P < .001). Among patients with sepsis, diabetes mellitus was a significant and independent predictor of respiratory dysfunction (odds ratio, 0.80; 95% confidence interval, 0.66–0.98) after adjustments for age, sex, ethnicity, admission to intensive care, number of comorbid conditions, and other infection sources. Conclusion Among an Asian population, respiratory dysfunction in patients with sepsis is less likely to develop in those with diabetes than in those without diabetes.

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The effect of comorbidity and age on hospital mortality and length of stay in patients with sepsis

Cited by 123 publications

References 30 publications

A scoring system to predict in-hospital death in oldest-old patients with infections in Taiwan

A scoring system to predict in-hospital death in oldest-old patients with infections in Taiwan

Prognostic Impact of the Charlson Comorbidity Index on Mortality following Acute Pulmonary Embolism

Respiratory Dysfunction in Patients With Sepsis: Protective Effect of Diabetes Mellitus

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