Cargando…

Outcomes and Predictors of In-Hospital Mortality among Older Patients with Dementia

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 eval...

Descripción completa

Detalles Bibliográficos
Autores principales: De Matteis, Giuseppe, Burzo, Maria Livia, Della Polla, Davide Antonio, Serra, Amato, Russo, Andrea, Landi, Francesco, Gasbarrini, Antonio, Gambassi, Giovanni, Franceschi, Francesco, Covino, Marcello
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9821230/
https://www.ncbi.nlm.nih.gov/pubmed/36614856
http://dx.doi.org/10.3390/jcm12010059
_version_ 1784865647769944064
author De Matteis, Giuseppe
Burzo, Maria Livia
Della Polla, Davide Antonio
Serra, Amato
Russo, Andrea
Landi, Francesco
Gasbarrini, Antonio
Gambassi, Giovanni
Franceschi, Francesco
Covino, Marcello
author_facet De Matteis, Giuseppe
Burzo, Maria Livia
Della Polla, Davide Antonio
Serra, Amato
Russo, Andrea
Landi, Francesco
Gasbarrini, Antonio
Gambassi, Giovanni
Franceschi, Francesco
Covino, Marcello
author_sort De Matteis, Giuseppe
collection PubMed
description 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.
format Online
Article
Text
id pubmed-9821230
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-98212302023-01-07 Outcomes and Predictors of In-Hospital Mortality among Older Patients with Dementia De Matteis, Giuseppe Burzo, Maria Livia Della Polla, Davide Antonio Serra, Amato Russo, Andrea Landi, Francesco Gasbarrini, Antonio Gambassi, Giovanni Franceschi, Francesco Covino, Marcello J Clin Med Article 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. MDPI 2022-12-21 /pmc/articles/PMC9821230/ /pubmed/36614856 http://dx.doi.org/10.3390/jcm12010059 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
De Matteis, Giuseppe
Burzo, Maria Livia
Della Polla, Davide Antonio
Serra, Amato
Russo, Andrea
Landi, Francesco
Gasbarrini, Antonio
Gambassi, Giovanni
Franceschi, Francesco
Covino, Marcello
Outcomes and Predictors of In-Hospital Mortality among Older Patients with Dementia
title Outcomes and Predictors of In-Hospital Mortality among Older Patients with Dementia
title_full Outcomes and Predictors of In-Hospital Mortality among Older Patients with Dementia
title_fullStr Outcomes and Predictors of In-Hospital Mortality among Older Patients with Dementia
title_full_unstemmed Outcomes and Predictors of In-Hospital Mortality among Older Patients with Dementia
title_short Outcomes and Predictors of In-Hospital Mortality among Older Patients with Dementia
title_sort outcomes and predictors of in-hospital mortality among older patients with dementia
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9821230/
https://www.ncbi.nlm.nih.gov/pubmed/36614856
http://dx.doi.org/10.3390/jcm12010059
work_keys_str_mv AT dematteisgiuseppe outcomesandpredictorsofinhospitalmortalityamongolderpatientswithdementia
AT burzomarialivia outcomesandpredictorsofinhospitalmortalityamongolderpatientswithdementia
AT dellapolladavideantonio outcomesandpredictorsofinhospitalmortalityamongolderpatientswithdementia
AT serraamato outcomesandpredictorsofinhospitalmortalityamongolderpatientswithdementia
AT russoandrea outcomesandpredictorsofinhospitalmortalityamongolderpatientswithdementia
AT landifrancesco outcomesandpredictorsofinhospitalmortalityamongolderpatientswithdementia
AT gasbarriniantonio outcomesandpredictorsofinhospitalmortalityamongolderpatientswithdementia
AT gambassigiovanni outcomesandpredictorsofinhospitalmortalityamongolderpatientswithdementia
AT franceschifrancesco outcomesandpredictorsofinhospitalmortalityamongolderpatientswithdementia
AT covinomarcello outcomesandpredictorsofinhospitalmortalityamongolderpatientswithdementia