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

Overview

Journal Clin Epidemiol

Publisher Dove Medical Press

Specialty Public Health

Date 2023 Jun 16

PMID 37324726

Authors

Amalia Laerke Kjaer Helto

Emilie Vangsgaard Rosager

Martin Aasbrenn

Cathrine Fox Maule

Janne Petersen

Finn Erland Nielsen

Charlotte Suetta

Rasmus Gregersen

Affiliations

Soon will be listed here.

Abstract

Purpose: Over coming decades, a rise in the number of short, acute hospitalizations of older people is to be expected. To help physicians identify high-risk patients prior to discharge, we aimed to develop a model capable of predicting the risk of 30-day mortality for older patients discharged from short, acute hospitalizations and to examine how model performance changed with an increasing amount of information.

Methods: This registry-based study included acute hospitalizations in Denmark for 2016-2018 lasting ≤24 hours where patients were permanent residents, ≥65 years old, and discharged alive. Utilizing many different predictor variables, we developed random forest models with an increasing amount of information, compared their performance, and examined important variables.

Results: We included 107,132 patients with a median age of 75 years. Of these, 3.3% (n=3575) died within 30 days of discharge. Model performance improved especially with the addition of laboratory results and information on prior acute admissions (AUROC 0.835), and again with comorbidities and number of prescription drugs (AUROC 0.860). Model performance did not improve with the addition of sociodemographic variables (AUROC 0.861), apart from age and sex. Important variables included age, dementia, number of prescription drugs, C-reactive protein, and eGFR.

Conclusion: The best model accurately estimated the risk of short-term mortality for older patients following short, acute hospitalizations. Trained on a large and heterogeneous dataset, the model is applicable to most acute clinical settings and could be a useful tool for physicians prior to discharge.

References

de Gelder J, Lucke J, Heim N, de Craen A, Lourens S, Steyerberg E . Predicting mortality in acutely hospitalized older patients: a retrospective cohort study. Intern Emerg Med. 2016; 11(4):587-94. PMC: 4853459. DOI: 10.1007/s11739-015-1381-7. View

Aasbrenn M, Christiansen C, Esen B, Suetta C, Nielsen F . Mortality of older acutely admitted medical patients after early discharge from emergency departments: a nationwide cohort study. BMC Geriatr. 2021; 21(1):410. PMC: 8252197. DOI: 10.1186/s12877-021-02355-y. View

Glynn N, Gmelin T, Renner S, Qiao Y, Boudreau R, Feitosa M . Perceived Physical Fatigability Predicts All-Cause Mortality in Older Adults. J Gerontol A Biol Sci Med Sci. 2021; 77(4):837-841. PMC: 8974332. DOI: 10.1093/gerona/glab374. View

Campbell S, Seymour D, Primrose W . A systematic literature review of factors affecting outcome in older medical patients admitted to hospital. Age Ageing. 2004; 33(2):110-5. DOI: 10.1093/ageing/afh036. View

Edmans J, Bradshaw L, Gladman J, Franklin M, Berdunov V, Elliott R . The Identification of Seniors at Risk (ISAR) score to predict clinical outcomes and health service costs in older people discharged from UK acute medical units. Age Ageing. 2013; 42(6):747-53. PMC: 3809718. DOI: 10.1093/ageing/aft054. View

Faisal M, Howes R, Steyerberg E, Richardson D, Mohammed M . Using routine blood test results to predict the risk of death for emergency medical admissions to hospital: an external model validation study. QJM. 2016; 110(1):27-31. DOI: 10.1093/qjmed/hcw110. View

Klinge M, Aasbrenn M, Ozturk B, Christiansen C, Suetta C, Pressel E . Readmission of older acutely admitted medical patients after short-term admissions in Denmark: a nationwide cohort study. BMC Geriatr. 2020; 20(1):203. PMC: 7291666. DOI: 10.1186/s12877-020-01599-4. View

Rosella L, Calzavara A, Frank J, Fitzpatrick T, Donnelly P, Henry D . Narrowing mortality gap between men and women over two decades: a registry-based study in Ontario, Canada. BMJ Open. 2017; 6(11):e012564. PMC: 5129136. DOI: 10.1136/bmjopen-2016-012564. View

Bryan K . Policies for reducing delayed discharge from hospital. Br Med Bull. 2010; 95:33-46. DOI: 10.1093/bmb/ldq020. View

10.

Bail K, Draper B, Berry H, Karmel R, Goss J . Predicting excess cost for older inpatients with clinical complexity: A retrospective cohort study examining cognition, comorbidities and complications. PLoS One. 2018; 13(2):e0193319. PMC: 5825075. DOI: 10.1371/journal.pone.0193319. View

11.

Robards J, Evandrou M, Falkingham J, Vlachantoni A . Marital status, health and mortality. Maturitas. 2012; 73(4):295-9. PMC: 3635122. DOI: 10.1016/j.maturitas.2012.08.007. View

12.

Juul-Larsen H, Christensen L, Bandholm T, Andersen O, Kallemose T, Jorgensen L . Patterns of Multimorbidity and Differences in Healthcare Utilization and Complexity Among Acutely Hospitalized Medical Patients (≥65 Years) - A Latent Class Approach. Clin Epidemiol. 2020; 12:245-259. PMC: 7053819. DOI: 10.2147/CLEP.S226586. View

13.

Vest-Hansen B, Riis A, Christiansen C . Registration of acute medical hospital admissions in the Danish National Patient Registry: a validation study. Clin Epidemiol. 2013; 5:129-33. PMC: 3641813. DOI: 10.2147/CLEP.S41905. View

14.

Graversen S, Pedersen H, Sandbaek A, Foss C, Palmer V, Ribe A . Dementia and the risk of short-term readmission and mortality after a pneumonia admission. PLoS One. 2021; 16(1):e0246153. PMC: 7842970. DOI: 10.1371/journal.pone.0246153. View

15.

. Ascent of machine learning in medicine. Nat Mater. 2019; 18(5):407. DOI: 10.1038/s41563-019-0360-1. View

16.

Strom C, Mollerup T, Kromberg L, Rasmussen L, Schmidt T . Hospitalisation in an emergency department short-stay unit compared to an internal medicine department is associated with fewer complications in older patients - an observational study. Scand J Trauma Resusc Emerg Med. 2017; 25(1):80. PMC: 5558657. DOI: 10.1186/s13049-017-0422-9. View

17.

Steinmeyer Z, Piau A, Thomazeau J, Huo Yung Kai S, Nourhashemi F . Mortality in hospitalised older patients: the WHALES short-term predictive score. BMJ Support Palliat Care. 2021; . DOI: 10.1136/bmjspcare-2021-003258. View

18.

OBrien R, Ishwaran H . A Random Forests Quantile Classifier for Class Imbalanced Data. Pattern Recognit. 2019; 90:232-249. PMC: 6370055. DOI: 10.1016/j.patcog.2019.01.036. View

19.

Buurman B, van Munster B, Korevaar J, Abu-Hanna A, Levi M, de Rooij S . Prognostication in acutely admitted older patients by nurses and physicians. J Gen Intern Med. 2008; 23(11):1883-9. PMC: 2585689. DOI: 10.1007/s11606-008-0741-7. View

20.

Henderson R, Keiding N . Individual survival time prediction using statistical models. J Med Ethics. 2005; 31(12):703-6. PMC: 1734073. DOI: 10.1136/jme.2005.012427. View