Agustín Julián-Jiménez1, Juan González-Del-Castillo2, Mikel Martínez-Ortiz-de-Zárate3, María Jesús Arranz-Nieto4, Félix González-Martínez5, Pascual Piñera-Salmerón6, Carmen Navarro-Bustos7, César Henríquez-Camacho8, Eric Jorge García-Lamberechts2. 1. Servicio de Urgencias, Complejo Hospitalario de Toledo, Toledo, España. Electronic address: agustinj@sescam.jccm.es. 2. Servicio de Urgencias, Hospital Universitario Clínico San Carlos, Madrid, España. 3. Servicio de Urgencias, Hospital Universitario de Basurto, Bilbao, España. 4. Servicio de Urgencias, Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo, España. 5. Servicio de Urgencias, Hospital Virgen de la Luz, Cuenca, España. 6. Servicio de Urgencias, Hospital Universitario Reina Sofía, Murcia, España. 7. Servicio de Urgencias, Hospital Universitario Virgen de la Macarena, Sevilla, España. 8. Servicio de Urgencias, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
Abstract
OBJECTIVES: To analyse factors associated with short-term mortality in elderly patients seen in emergency departments (ED) for an episode of infectious disease. MATERIALS AND METHODS: A prospective, observational, multicentre, analytical study was carried out on patients aged 75years and older who were treated in the ED of one of the eight participating hospitals. An assessment was made of 26 independent variables that could influence mortality at 30days. They covered epidemiological, comorbidity, functional, clinical and analytical factors. Multivariate logistic regression analysis was performed. RESULTS: The study included 488 consecutive patients, 92 (18.9%) of whom died within 30days of visiting the ED. Three variables were significantly associated with higher mortality: severe functional dependence, with Barthel index ≤60 [odds ratio (OR) 8,92; 95% confidence interval (CI): 4.98-15.98, P=.003], systolic blood pressure <90mmHg [OR 7.34; 95%CI: 4.39-12.26, P=.005] and serum lactate >4mmol/l [OR 21.14; 95%CI: 8.94-49.97, P=.001]. The area under the curve for the model was 0.971 (95%CI: 0.951-0.991; P<.001). CONCLUSIONS: Several factors evaluated in an initial assessment in the ED, including the level of functional dependence, systolic blood pressure and, especially, serum lactate, were found to determine a poor short-term prognosis in the elderly patients who presented with an episode of an infectious disease.
OBJECTIVES: To analyse factors associated with short-term mortality in elderly patients seen in emergency departments (ED) for an episode of infectious disease. MATERIALS AND METHODS: A prospective, observational, multicentre, analytical study was carried out on patients aged 75years and older who were treated in the ED of one of the eight participating hospitals. An assessment was made of 26 independent variables that could influence mortality at 30days. They covered epidemiological, comorbidity, functional, clinical and analytical factors. Multivariate logistic regression analysis was performed. RESULTS: The study included 488 consecutive patients, 92 (18.9%) of whom died within 30days of visiting the ED. Three variables were significantly associated with higher mortality: severe functional dependence, with Barthel index ≤60 [odds ratio (OR) 8,92; 95% confidence interval (CI): 4.98-15.98, P=.003], systolic blood pressure <90mmHg [OR 7.34; 95%CI: 4.39-12.26, P=.005] and serum lactate >4mmol/l [OR 21.14; 95%CI: 8.94-49.97, P=.001]. The area under the curve for the model was 0.971 (95%CI: 0.951-0.991; P<.001). CONCLUSIONS: Several factors evaluated in an initial assessment in the ED, including the level of functional dependence, systolic blood pressure and, especially, serum lactate, were found to determine a poor short-term prognosis in the elderly patients who presented with an episode of an infectious disease.
Authors: R Rubio Díaz; E de Rafael González; E Martín Torres; E Valera Núñez; A M López Martos; D Melguizo Melguizo; M P Picazo Perea; P J López García; P Fuentes Bullejos; M Chafer Rudilla; J F Carretero Gómez; A Julián-Jiménez Journal: Rev Esp Quimioter Date: 2021-12-03 Impact factor: 1.553