A simple 5-point scoring system, NaURSE (Na+, Urea, Respiratory Rate and Shock Index in the Elderly), predicts in-hospital mortality in oldest old

Alexander H. Wilson, Andrew C Kidd, Jane Skinner, Patrick Musonda, Yogish Pai, Claire J. Lunt, Catherine Butchart, Roy Soiza, John F Potter, Phyo Kyaw Myint

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

BACKGROUND: the mortality is high in acutely ill oldest old patients. Understanding the prognostic factors which influence mortality will help clinicians make appropriate management decisions.

METHODS: we analysed prospective mortality audit data (November 2008 to January 2009) to identify variables associated with in-patient mortality in oldest old. We selected those with P < 0.10 from univariate analysis and determined at which cut-point they served as the strongest predictor of mortality. Using these cut-off points, we constructed multivariate logistic regression models. A 5-point score was derived from cut-off points which were significantly associated with mortality tested in a smaller independent re-audit sample conducted in October 2011.

RESULTS: a total of 405 patients (mean 93.5 ± 2.7 years) were included in the study. The mean length of stay was 18.5 ± 42.4 days and 13.8% died as in-patients. Variables (cut-off values) found to be significantly associated with in-patient mortality were admission sodium (>145 mmol/l), urea (≥14 mmol/l), respiratory rate (>20/min) and shock index (>1.0): creating a 5-point score (NaURSE: NaURS in the Elderly). The crude mortality rates were 9.5, 19.9, 34.4, 66.7, and 100% for scores 0, 1, 2, 3 and 4, respectively. Using the cut-off point of ≥2, the NaURSE score has a specificity of 87% (83.1-90.3) and sensitivity of 39% (28.5-50.0), with an AUC value of 0.69 (0.63-0.76). An external independent validation study (n = 121) showed similar results.

CONCLUSIONS: the NaURSE score may be particularly useful in identifying oldest old who are likely to die in that admission to guide appropriate care.

Original languageEnglish
Pages (from-to)352-357
Number of pages6
JournalAge and Ageing
Volume43
Issue number3
Early online date31 Jan 2014
DOIs
Publication statusPublished - May 2014

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Respiratory Rate
Hospital Mortality
Urea
Shock
Mortality
Logistic Models
Validation Studies
Area Under Curve
Length of Stay
Sodium

Keywords

  • mortality
  • older people
  • oldest old
  • prognostic score

Cite this

A simple 5-point scoring system, NaURSE (Na+, Urea, Respiratory Rate and Shock Index in the Elderly), predicts in-hospital mortality in oldest old. / Wilson, Alexander H. ; Kidd, Andrew C; Skinner, Jane; Musonda, Patrick; Pai, Yogish; Lunt, Claire J.; Butchart, Catherine; Soiza, Roy; Potter, John F; Myint, Phyo Kyaw.

In: Age and Ageing, Vol. 43, No. 3, 05.2014, p. 352-357.

Research output: Contribution to journalArticle

Wilson, Alexander H. ; Kidd, Andrew C ; Skinner, Jane ; Musonda, Patrick ; Pai, Yogish ; Lunt, Claire J. ; Butchart, Catherine ; Soiza, Roy ; Potter, John F ; Myint, Phyo Kyaw. / A simple 5-point scoring system, NaURSE (Na+, Urea, Respiratory Rate and Shock Index in the Elderly), predicts in-hospital mortality in oldest old. In: Age and Ageing. 2014 ; Vol. 43, No. 3. pp. 352-357.
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abstract = "BACKGROUND: the mortality is high in acutely ill oldest old patients. Understanding the prognostic factors which influence mortality will help clinicians make appropriate management decisions. METHODS: we analysed prospective mortality audit data (November 2008 to January 2009) to identify variables associated with in-patient mortality in oldest old. We selected those with P < 0.10 from univariate analysis and determined at which cut-point they served as the strongest predictor of mortality. Using these cut-off points, we constructed multivariate logistic regression models. A 5-point score was derived from cut-off points which were significantly associated with mortality tested in a smaller independent re-audit sample conducted in October 2011. RESULTS: a total of 405 patients (mean 93.5 ± 2.7 years) were included in the study. The mean length of stay was 18.5 ± 42.4 days and 13.8{\%} died as in-patients. Variables (cut-off values) found to be significantly associated with in-patient mortality were admission sodium (>145 mmol/l), urea (≥14 mmol/l), respiratory rate (>20/min) and shock index (>1.0): creating a 5-point score (NaURSE: NaURS in the Elderly). The crude mortality rates were 9.5, 19.9, 34.4, 66.7, and 100{\%} for scores 0, 1, 2, 3 and 4, respectively. Using the cut-off point of ≥2, the NaURSE score has a specificity of 87{\%} (83.1-90.3) and sensitivity of 39{\%} (28.5-50.0), with an AUC value of 0.69 (0.63-0.76). An external independent validation study (n = 121) showed similar results. CONCLUSIONS: the NaURSE score may be particularly useful in identifying oldest old who are likely to die in that admission to guide appropriate care.",
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T1 - A simple 5-point scoring system, NaURSE (Na+, Urea, Respiratory Rate and Shock Index in the Elderly), predicts in-hospital mortality in oldest old

AU - Wilson, Alexander H.

AU - Kidd, Andrew C

AU - Skinner, Jane

AU - Musonda, Patrick

AU - Pai, Yogish

AU - Lunt, Claire J.

AU - Butchart, Catherine

AU - Soiza, Roy

AU - Potter, John F

AU - Myint, Phyo Kyaw

PY - 2014/5

Y1 - 2014/5

N2 - BACKGROUND: the mortality is high in acutely ill oldest old patients. Understanding the prognostic factors which influence mortality will help clinicians make appropriate management decisions. METHODS: we analysed prospective mortality audit data (November 2008 to January 2009) to identify variables associated with in-patient mortality in oldest old. We selected those with P < 0.10 from univariate analysis and determined at which cut-point they served as the strongest predictor of mortality. Using these cut-off points, we constructed multivariate logistic regression models. A 5-point score was derived from cut-off points which were significantly associated with mortality tested in a smaller independent re-audit sample conducted in October 2011. RESULTS: a total of 405 patients (mean 93.5 ± 2.7 years) were included in the study. The mean length of stay was 18.5 ± 42.4 days and 13.8% died as in-patients. Variables (cut-off values) found to be significantly associated with in-patient mortality were admission sodium (>145 mmol/l), urea (≥14 mmol/l), respiratory rate (>20/min) and shock index (>1.0): creating a 5-point score (NaURSE: NaURS in the Elderly). The crude mortality rates were 9.5, 19.9, 34.4, 66.7, and 100% for scores 0, 1, 2, 3 and 4, respectively. Using the cut-off point of ≥2, the NaURSE score has a specificity of 87% (83.1-90.3) and sensitivity of 39% (28.5-50.0), with an AUC value of 0.69 (0.63-0.76). An external independent validation study (n = 121) showed similar results. CONCLUSIONS: the NaURSE score may be particularly useful in identifying oldest old who are likely to die in that admission to guide appropriate care.

AB - BACKGROUND: the mortality is high in acutely ill oldest old patients. Understanding the prognostic factors which influence mortality will help clinicians make appropriate management decisions. METHODS: we analysed prospective mortality audit data (November 2008 to January 2009) to identify variables associated with in-patient mortality in oldest old. We selected those with P < 0.10 from univariate analysis and determined at which cut-point they served as the strongest predictor of mortality. Using these cut-off points, we constructed multivariate logistic regression models. A 5-point score was derived from cut-off points which were significantly associated with mortality tested in a smaller independent re-audit sample conducted in October 2011. RESULTS: a total of 405 patients (mean 93.5 ± 2.7 years) were included in the study. The mean length of stay was 18.5 ± 42.4 days and 13.8% died as in-patients. Variables (cut-off values) found to be significantly associated with in-patient mortality were admission sodium (>145 mmol/l), urea (≥14 mmol/l), respiratory rate (>20/min) and shock index (>1.0): creating a 5-point score (NaURSE: NaURS in the Elderly). The crude mortality rates were 9.5, 19.9, 34.4, 66.7, and 100% for scores 0, 1, 2, 3 and 4, respectively. Using the cut-off point of ≥2, the NaURSE score has a specificity of 87% (83.1-90.3) and sensitivity of 39% (28.5-50.0), with an AUC value of 0.69 (0.63-0.76). An external independent validation study (n = 121) showed similar results. CONCLUSIONS: the NaURSE score may be particularly useful in identifying oldest old who are likely to die in that admission to guide appropriate care.

KW - mortality

KW - older people

KW - oldest old

KW - prognostic score

U2 - 10.1093/ageing/afu002

DO - 10.1093/ageing/afu002

M3 - Article

VL - 43

SP - 352

EP - 357

JO - Age and Ageing

JF - Age and Ageing

SN - 0002-0729

IS - 3

ER -