Association between routine laboratory tests and long-term mortality among acutely admitted older medical patients: a cohort study

BMC Geriatrics

Research Article

Juliette Tavenier¹  Henrik Hedegaard Klausen¹  Helle Gybel Juul-Larsen¹  Jesper Eugen-Olsen¹  Thomas Bandholm²  Janne Petersen³  Ove Andersen⁴ 

[1] Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark;Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark;Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark;Department of Physical Therapy, Physical Medicine & Rehabilitation Research – Copenhagen (PMR-C), Copenhagen University Hospital, Hvidovre, Denmark;Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark;Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark;Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark;The Emergency Department, Copenhagen University Hospital, Hvidovre, Denmark;

关键词: Reference Interval;    Frailty Index;    Index Hospitalisation;    Fourth Quartile;    Acute Admission;   

DOI  :  10.1186/s12877-017-0434-3

 received in 2016-09-28, accepted in 2017-01-25,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundOlder people have the highest incidence of acute medical admissions. Old age and acute hospital admissions are associated with a high risk of adverse health outcomes after discharge, such as reduced physical performance, readmissions and mortality. Hospitalisations in this population are often by acute admission and through the emergency department. This, along with the rapidly increasing proportion of older people, warrants the need for clinically feasible tools that can systematically assess vulnerability in older medical patients upon acute hospital admission. These are essential for prioritising treatment during hospitalisation and after discharge.Here we explore whether an abbreviated form of the FI-Lab frailty index, calculated as the number of admission laboratory test results outside of the reference interval (FI-OutRef) was associated with long term mortality among acutely admitted older medical patients. Secondly, we investigate other markers of aging (age, total number of chronic diagnoses, new chronic diagnoses, and new acute admissions) and their associations with long-term mortality.MethodsA cohort study of acutely admitted medical patients aged 65 or older. Survival time within a 3 years post-discharge follow up period was used as the outcome. The associations between the markers and survival time were investigated by Cox regression analyses. For analyses, all markers were grouped by quartiles.ResultsA total of 4,005 patients were included. Among the 3,172 patients without a cancer diagnosis, mortality within 3 years was 39.9%. Univariate and multiple regression analyses for each marker showed that all were significantly associated with post-discharge survival. The changes between the estimates for the FI-OutRef quartiles in the univariate- and the multiple analyses were negligible. Among all the markers investigated, FI-OutRef had the highest hazard ratio of the fourth quartile versus the first quartile: 3.45 (95% CI: 2.83-s4.22, P < 0.001).ConclusionAmong acutely admitted older medical patients, FI-OutRef was strongly associated with long-term mortality. This association was independent of age, sex, and number of chronic diagnoses, new chronic diagnoses, and new acute admissions. Hence FI-OutRef could be a biomarker of advancement of aging within the acute care setting.

【 授权许可】

CC BY   
© The Author(s). 2017