Development and Validation of a Prognostic Index for 1-Year Mortality in Older Adults After Hospitalization

• Published in: JAMA : the journal of the American Medical Association 2001-06, Vol.285 (23), p.2987-2994
• Main Authors: Walter, Louise C, Brand, Richard J, Counsell, Steven R, Palmer, Robert M, Landefeld, C. Seth, Fortinsky, Richard H, Covinsky, Kenneth E
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Female; Health risk assessment; Health Status Indicators; Hospitalization; Hospitalization - statistics & numerical data; Humans; Logistic Models; Male; Medical sciences; Miscellaneous; Mortality; Multivariate Analysis; Older people; Prevention and actions; Prognosis; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Assessment; Risk Factors
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.285.23.2987

CONTEXT For many elderly patients, an acute medical illness requiring hospitalization is followed by a progressive decline, resulting in high rates of mortality in this population during the year following discharge. However, few prognostic indices have focused on predicting posthospital mortality in older adults. OBJECTIVE To develop and validate a prognostic index for 1 year mortality of older adults after hospital discharge using information readily available at discharge. DESIGN Data analyses derived from 2 prospective studies with 1-year of follow-up, conducted in 1993 through 1997. SETTING AND PATIENTS We developed the prognostic index in 1495 patients aged at least 70 years who were discharged from a general medical service at a tertiary care hospital (mean age, 81 years; 67% female) and validated it in 1427 patients discharged from a separate community teaching hospital (mean age, 79 years; 61% female). MAIN OUTCOME MEASURE Prediction of 1-year mortality using risk factors such as demographic characteristics, activities of daily living (ADL) dependency, comorbid conditions, length of hospital stay, and laboratory measurements. RESULTS In the derivation cohort, 6 independent risk factors for mortality were identified and weighted using logistic regression: male sex (1 point); number of dependent ADLs at discharge (1-4 ADLs, 2 points; all 5 ADLs, 5 points); congestive heart failure (2 points); cancer (solitary, 3 points; metastatic, 8 points); creatinine level higher than 3.0 mg/dL (265 µmol/L) (2 points); and low albumin level (3.0-3.4 g/dL, 1 point; 6 points). In the validation cohort, 1-year mortality was 4% in the lowest-risk group, 19% in the group with 2 or 3 points, 34% in the group with 4 to 6 points, and 64% in the highest-risk group. The area under the receiver operating characteristic curve for the point system was 0.75 in the derivation cohort and 0.79 in the validation cohort. CONCLUSIONS Our prognostic index, which used 6 risk factors