24-hours mortality in seniors hospitalised with medical conditions

Czech version

Authors: Martin Dúbrava ¹; Soňa Kiňová ²; Jarmila Jánošiová ¹
Authors‘ workplace: I. klinika geriatrie LF UK a UN Bratislava ¹; I. interná klinika LF UK a UN Bratislava ²
Published in: Vnitř Lék 2021; 67(E-6): 3-7
Category: Original Contributions

Overview

Aim: Mortality is the hardest outcome characterising the severity of diseases and the result of the health care. It is connected mainly with elderly patients (pts.). Information on 24-hours hospital mortality (M24) in seniors admitted to nonsurgical departments is scarce.

Patients and methods: In a retrospective observational study, we investigated M24 in pts. of 65 years of age and older, who were discharged from an university geriatric department in years 2016–2018. The identification of diseases which primarily led to M24 and their classification was independently performed by authors from geriatric and internal medicine departments.

Results: We proved that M24 is rather frequent (2.3 % out of all hospitalised pts.). There was a 2.4-fold M24 incidence increase from the age 65–69 years up to ≥ 90 years (from 1.4 to 3.3 %). The average age of deceased M24 pts. (n = 101) was 80.8 years and was not different from the age of those who deceased later. The majority of M24 (58.4 %) occurred during the first 12 hours after the admission to the hospital. There were many diseases (n = 25) that primarily led to M24 with dominating cardiovascular pathologies (39.6 %), followed closely by infective diseases (33.7 %). Therapeutically irreversible advanced chronic diseases led to M24 in 15.8 %. There was a higher frequency of acute diseases therapeutically irreversibly decompensating pre-existing diseases (43.6 %) than that of acute diseases incompatible with survival (33.7 %).

Keywords:

geriatrics – mortality – 24-hours

Sources

1. Dúbrava M. Indikátory kvality zdravotnej starostlivosti v geriatrii. Geriatria 2016; 22(1): 35–40.

2. Lazzeri C, Valente S, Chiostri M, Picariello C, Gensini GF. Predictors of the early outcome in elderly patients with ST elevation myocardial infarction treated with primary angioplasty: a single center experience. Intern Emerg Med. 2011; 6(1): 41–46.

3. Claussen PA, Abdelnoor M, Kvakkestad KM, Eritsland J, Halvorsen S. Prevalence of risk factors at presentation and early mortality in patients aged 80 years or older with ST-segment elevation myocardial infarction. Vasc Health Risk Manag 2014; 10: 683–689.

4. Putthapiban P, Vutthikraivit W, Rattanawong P et al. Association of frailty with all-cause mortality and bleeding among elderly patients with acute myocardial infarction: a systematic review and meta-analysis. J Geriatr Cardiol 2020; 17(5): 270–278.

5. Gassa A, Borghardt JH, Maier J, et al. Effect of preoperative low serum albumin on postoperative complications and early mortality in patients undergoing transcatheter aortic valve replacement. J Thorac Dis 2018; 10(12): 6763–6770.

6. Jung JC, Jang MJ, Hwang HY. Meta-Analysis Comparing Mitral Valve Repair Versus Replacement for Degenerative Mitral Regurgitation Across All Ages. Am J Cardiol 2019; 123(3): 446–453.

7. Herrero-Puente P, Martín-Sánchez FJ, Fernández-Fernández M et al. Differential clinical characteristics and outcome predictors of acute heart failure in elderly patients. Int J Cardiol. 2012; 155(1): 81–86.

8. Herrero-Puente P, Marino-Genicio R, Martín-Sánchez FJ et al. Characteristics of acute heart failure in very elderly patients – EVE study (EAHFE very elderly). Eur J Intern Med 2014; 25(5): 463–470.

9. Otero-López MS, Martínez-Ocaña JC, Betancourt-Castellanos L, Rodríguez-Salazar E, García-García M. Two prognostic scores for early mortality and their clinical applicability in elderly patients on haemodialysis: poor predictive success in individual patients. Nefrologia 2012; 32(2): 213–220.

10. De La Higuera L, Riva E, Djade CD et al. Prognostic value of estimated glomerular filtration rate in hospitalized elderly patients. Intern Emerg Med 2014; 9(7): 735–747.

11. Thamer M, Kaufman JS, Zhang Y, Zhang Q, Cotter DJ, Bang H. Predicting Early Death Among Elderly Dialysis Patients: Development and Validation of a Risk Score to Assist Shared Decision Making for Dialysis Initiation. Am J Kidney Dis 2015; 66(6): 1024–1032.

12. Van Loon IN, Goto NA, Boereboom FTJ et al. Geriatric Assessment and the Relation with Mortality and Hospitalizations in Older Patients Starting Dialysis. Nephron 2019; 143(2): 108–119.

13. Poblete RA, Zheng L, Arenas M et al. Older Age Is Not Associated with Worse Outcomes Following Decompressive Hemicraniectomy for Spontaneous Intracerebral Hemorrhage. J Stroke Cerebrovasc Dis 2019; 28(11): 104320.

14. Oliveira ADP, Andrade-Valença LPA, Valença MM. Factors Associated With In-Hospital Mortality in Very Elderly Patients With Ischemic Stroke: A Cohort Study. J Stroke Cerebrovasc Dis 2019; 28(10): 104281.

15. Dehlendorff C, Andersen KK, Olsen TS. Early case-fatality rates in elderly stroke patients do not increase when age increases. Geriatr Gerontol Int. 2014; 14(4): 786–792.

16. Ewig S, Birkner N, Strauss R et al. New perspectives on community-acquired pneumonia in 388 406 patients. Results from a nationwide mandatory performance measurement programme in healthcare quality. Thorax 2009; 64(12): 1062–1069.

17. Retamar P, López-Prieto MD, Rodríguez-López F et al. Predictors of early mortality in very elderly patients with bacteremia: a prospective multicenter cohort. Int J Infect Dis 2014; 26: 83–87.

18. Kovar FM, Endler G, Wagner OF, Jaindl M. Basal haemoglobin levels as prognostic factor for early death in elderly patients with a hip fracture. A twenty year observation study. Injury 2015; 46(6): 1018–1022.

19. Lizaur-Utrilla A, Gonzalez-Navarro B, Vizcaya-Moreno MF, Lopez-Prats FA. Altered seric levels of albumin, sodium and parathyroid hormone may predict early mortality following hip fracture surgery in elderly. Int Orthop 2019; 43(12): 2825–2829.

20. De Groot R, Nijmeijer WS, Folbert EC, Vollenbroek-Hutten MMR, Hegeman JH. ‘Nonagenarians’ with a hip fracture: is a different orthogeriatric treatment strategy necessary? Arch Osteoporos 2020; 15(1): 19.

21. Boulahssass R, Gonfrier S, Ferrero JM et al. Predicting early death in older adults with cancer. Eur J Cancer 2018; 100: 65–74.

22. Chou WC, Chang H, Wang PN et al. Application of comprehensive geriatric assessment in predicting early mortality among elder patients with B-cell lymphoma receiving immunochemotherapy. Eur J Haematol 2020; 10.1111/ejh.13457 [published online ahead of print, 2020 May 30].

23. Liu CJ, Hong YC, Kuan AS et al. The risk of early mortality in elderly patients with newly diagnosed acute myeloid leukemia. Cancer Med. 2020; 9(4): 1572–1580.

24. Sineshaw HM, Yabroff KR, Tsikitis VL, Jemal A, Mitin T. Early Postoperative Mortality Among Patients Aged 75 Years or Older With Stage II/III Rectal Cancer. J Natl Compr Canc Netw 2020; 18(4): 443–451.

25. Pamoukdjian F, Aparicio T, Zebachi S, Zelek L, Paillaud E, Canoui-Poitrine F. Comparison of Mobility Indices for Predicting Early Death in Older Patients With Cancer: The Physical Frailty in Elderly Cancer Cohort Study. J Gerontol A Biol Sci Med Sci. 2020; 75(1): 189–196.

26. Avelino-Silva TJ, Campora F, Curiati JA, Jacob-Filho W. Association between delirium superimposed on dementia and mortality in hospitalized older adults: A prospective cohort study. PLoS Med. 2017; 14(3): e1002264.

27. Fonseca C, Araújo M, Moniz P et al. Prevalence and prognostic impact of anemia and iron deficiency in patients hospitalized in an internal medicine ward: The PRO-IRON study. Eur J Haematol 2017; 99(6): 505–513.

28. Dúbrava M, Németh F, Drobná T, Gerlich L. Kaliémia u seniorov s fibriláciou predsiení. (Údaje zo štúdie SAFIS.). Geriatria 2018; 24(2): 43–50.

29. Lorenzoni G, Swain S, Lanera C et al. High – and low-inpatients’ serum magnesium levels are associated with in-hospital mortality in elderly patients: a neglected marker?. Aging Clin Exp Res 2020; 32(3): 407–413.

30. Dúbrava M, Jánošiová J, Šuba J ml. Hyponatrémia u hospitalizovaných seniorov: prevalencia, závažnosť, dĺžka pobytu v nemocnici a nemocničná mortalita. Interná med 2020; 20(7–8): 341–343.

31. Kemp K, Mertanen R, Lääperi M, Niemi-Murola L, Lehtonen L, Castren M. Nonspecific complaints in the emergency department – a systematic review. Scand J Trauma Resusc Emerg Med 2020; 28(1): 6.

32. Haug N, Deischinger C, Gyimesi M, Kautzky-Willer A, Thurner S, Klimek P. High-risk multimorbidity patterns on the road to cardiovascular mortality. BMC Med 2020; 18(1): 44.

33. Vilches-Moraga A, Fox J, Paracha A, Gomez-Quintanilla A, Epstein J, Pearce L. Predicting in- -hospital mortality in older general surgical patients. Ann R Coll Surg Engl 2018; 100(7): 529–533.

34. Ball IM, Bagshaw SM, Burns KE et al. Outcomes of elderly critically ill medical and surgical patients: a multicentre cohort study. Pronostics des patients âgés et gravement malades en médecine et en chirurgie: une étude de cohorte multicentrique. Can J Anaesth 2017; 64(3): 260–269.

35. Atramont A, Lindecker-Cournil V, Rudant J et al. Association of Age With Short-term and Long-term Mortality Among Patients Discharged From Intensive Care Units in France. JAMA Netw Open 2019; 2(5): e193215.

36. Giannasi SE, Venuti MS, Midley AD, Roux N, Kecskes C, San Román E. Mortality risk factors in elderly patients in intensive care without limitation of therapeutic effort. Factores de riesgo de mortalidad de los pacientes ancianos en cuidados intensivos sin limitación del esfuerzo de tratamiento. Med Intensiva. 2018; 42(8): 482–489.

37. Brouns SHA, Wachelder JJ, Jonkers FS, Lambooij SL, Dieleman JP, Haak HR. Outcome of elderly emergency department patients hospitalised on weekends – a retrospective cohort study. BMC Emerg Med 2018; 18(1): 9.

38. Almagro P, Ponce A, Komal S et al. Multimorbidity gender patterns in hospitalized elderly patients. PLoS One. 2020; 15(1): e0227252.

39. Baldwin MR, Narain WR, Wunsch H et al. A prognostic model for 6-month mortality in elderly survivors of critical illness. Chest 2013; 143(4): 910–919.

40. Drame M, Jovenin N, Novella JL et al. Predicting early mortality among elderly patients hospitalised in medical wards via emergency department: the SAFES cohort study. J Nutr Health Aging 2008; 12(8): 599–604.

Labels

Diabetology Endocrinology Internal medicine

Post-intensive care syndrome

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Za doc. MUDr. Janem Malým, CSc.

Article was published in

Internal Medicine

2021 Issue E-6