PREDICTORS OF IN-HOSPITAL MORTALITY OF VERY ELDERLY PATIENTS IN THE WESTERN REGION OF NEPAL

Background: Because of increasing mortality of hospitalized very elderly patients, we aimed to study the factors associated with in-hospital mortality of this population and determine their predictive role.

Methods: This was a prospective observational study conducted among 204 patients of ≥85 years old, admitted to Manipal Teaching Hospital, Pokhara, Nepal. Different variables, particularly Acute Physiology and Chronic Health Evaluation (APACHE) II score, were studied for the association with in-hospital mortality; the logistic regression analysis was used to determine their predictive role.

Results: Among the hospitalized 204 patients (males 63.2%, females 36.8%), the mean age was 87.6±2.9 years, survival was 174 (85.3%) and mortality was 30 (14.7%). Among the hospitalized very elderly patients, the prevalence of hypertension was 51.5%, diabetes mellitus 12.7%, chronic obstructive pulmonary disease 25%, alcohol misuse 33.8%, smoking 32.4%, polypharmacy 57.4%, immobility 61.8%, stroke 18.1% and septicemia 15.2%. The overall mean APACHE II score was 17.8 (±5.2); in survival group, it was 16.4 (±4.1) and in mortality group, it was 25.5 (±4.2). The percentage of the patients with septicemia in survival group was 8.6% and that in mortality group was 53.3%. The variables associated with in-hospital mortality were diabetes mellitus, alcohol use, smoking, polypharmacy, stroke, septicemia and APACHE II score (p<0.05). The logistic regression analysis showed that the in-hospital mortality of very elderly patients could be predicted by APACHE II score [p<0.001, odds ratio (OR) 1.68, 95% confidence interval (CI) 1.34 to 2.11] and septicemia (p 0.027, OR 5.94, 95% CI 1.23 to 28.71). The area under receiver operating curve of APACHE II score for mortality was 0.94 (95% CI 0.89 to 0.99; P<0.001).

Conclusions: The age, diabetes mellitus, alcohol use, smoking, polypharmacy, stroke, septicemia and APACHE II score were associated with the increased mortality of the hospitalized very elderly patients in Nepal. The APACHE II score and septicemia were the significant predictors of in-hospital mortality in this population.