Dementia is associated with high rates of admission to hospital, due to acute illness, and in-hospital mortality. The study aimed to investigate the impact of dementia on in-hospital mortality and identify the predictors of in-hospital mortality in these patients. This was a retrospective study evaluating all the patients >= 65 years consecutively admitted to our Emergency Department (ED). We compared the clinical outcomes of the patients with dementia at ED admission with those who did not have dementia, using a propensity score-matched (PSM) paired cohort of controls. The patients were matched for age, sex, Charlson Comorbidity Index value, and clinical severity at presentation (based on NEWS >= 5). The primary study endpoint was all-cause in-hospital death. After the PSM, a total of 7118 patients, 3559 with dementia and 3559 in the control group, were included in the study cohort. The mean age was 84 years, and 59.8% were females. The overall mortality rate was higher for the demented patients compared with the controls (18.7% vs. 16.0%, p = 0.002). The multivariate-adjusted hazard ratio (HR) showed that dementia was an independent risk factor for death (HR 1.13 [1.01-1.27]; p = 0.033). In the patients with dementia, respiratory failure (HR 3.08 [2.6-3.65]), acute renal failure (HR 1.64 [1.33-2.02]; p < 0.001), hemorrhagic stroke (HR 1.84 [1.38-2.44]; p < 0.001), and bloodstream infection (HR 1.41 [1.17-1.71]; p = 0.001) were significant predictors of worse outcomes. Finally, the comorbidities and severity of illness at ED admission negatively influenced survival among the patients with dementia (CCI HR 1.05 [1.01-1.1] p = 0.005; NEWS >= 5 HR 2.45 [1.88-3.2] p < 0.001). In conclusion, among the hospitalized older patients, dementia was associated with a higher risk of mortality. Furthermore, among the older patients with dementia, respiratory failure and bloodstream infections were independently associated with an increased risk of in-hospital mortality.
De Matteis, G., Burzo, M. L., Della Polla, D. A., Serra, A., Russo, A., Landi, F., Gasbarrini, A., Gambassi, G., Franceschi, F., Covino, M., Outcomes and Predictors of In-Hospital Mortality among Older Patients with Dementia, <<JOURNAL OF CLINICAL MEDICINE>>, 2022; 12 (1): 59-62. [doi:10.3390/jcm12010059] [https://hdl.handle.net/10807/228009]
Outcomes and Predictors of In-Hospital Mortality among Older Patients with Dementia
De Matteis, GiuseppePrimo
Writing – Review & Editing
;Serra, AmatoInvestigation
;Russo, AndreaInvestigation
;Landi, FrancescoInvestigation
;Gasbarrini, AntonioMethodology
;Gambassi, GiovanniValidation
;Franceschi, FrancescoSupervision
;Covino, MarcelloUltimo
Conceptualization
2022
Abstract
Dementia is associated with high rates of admission to hospital, due to acute illness, and in-hospital mortality. The study aimed to investigate the impact of dementia on in-hospital mortality and identify the predictors of in-hospital mortality in these patients. This was a retrospective study evaluating all the patients >= 65 years consecutively admitted to our Emergency Department (ED). We compared the clinical outcomes of the patients with dementia at ED admission with those who did not have dementia, using a propensity score-matched (PSM) paired cohort of controls. The patients were matched for age, sex, Charlson Comorbidity Index value, and clinical severity at presentation (based on NEWS >= 5). The primary study endpoint was all-cause in-hospital death. After the PSM, a total of 7118 patients, 3559 with dementia and 3559 in the control group, were included in the study cohort. The mean age was 84 years, and 59.8% were females. The overall mortality rate was higher for the demented patients compared with the controls (18.7% vs. 16.0%, p = 0.002). The multivariate-adjusted hazard ratio (HR) showed that dementia was an independent risk factor for death (HR 1.13 [1.01-1.27]; p = 0.033). In the patients with dementia, respiratory failure (HR 3.08 [2.6-3.65]), acute renal failure (HR 1.64 [1.33-2.02]; p < 0.001), hemorrhagic stroke (HR 1.84 [1.38-2.44]; p < 0.001), and bloodstream infection (HR 1.41 [1.17-1.71]; p = 0.001) were significant predictors of worse outcomes. Finally, the comorbidities and severity of illness at ED admission negatively influenced survival among the patients with dementia (CCI HR 1.05 [1.01-1.1] p = 0.005; NEWS >= 5 HR 2.45 [1.88-3.2] p < 0.001). In conclusion, among the hospitalized older patients, dementia was associated with a higher risk of mortality. Furthermore, among the older patients with dementia, respiratory failure and bloodstream infections were independently associated with an increased risk of in-hospital mortality.File | Dimensione | Formato | |
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