Highlights
- •eGFR, anemia, sarcopenia, cognitive and functional status may affect prognosis.
- •Survival tree revealed relevant prognostic interactions among these risk factors.
- •Multidimensional assessment should be part of routine care for older patients.
Abstract
Background
Interactions between chronic kidney disease (CKD) and several comorbidities may potentially
affect prognosis of older hospitalized patients. This study aims at evaluating the
prognostic interactions between estimated glomerular filtration rate (eGFR), anemia,
sarcopenia, functional and cognitive dysfunction, and 3-year mortality among older
patients discharged from acute care hospitals.
Methods
Our series consisted of 504 older adults enrolled in a multicenter observational study
carried out in twelve Acute Geriatric and Internal Medicine wards throughout Italy.
CKD was defined as an eGFR< 60 ml/min/1.73 m2. Anemia, Short Portable Status Mental Questionnaire (SPMSQ), Basic Activities of
Daily Living (BADL), sarcopenia, and Charlson index were considered in the analysis.
3-year survival was investigated by Cox regression and prognostic interactions among
study variables were assessed by survival tree analysis. Accuracy of different survival
models was investigated by C-index.
Results
eGFR < 30 mL/min/1.73 m2, anemia, sarcopenia, SPMSQ ≥ 5, and impairment in 1 or more BADL were significantly
associated with mortality. Survival tree analysis showed that patients with eGFR < 35.32
ml/min/1.73 m2 and SPMSQ ≥ 5 had the highest risk of mortality [hazard ratio (HR): 5.49, 95%CI:
3.04–9.94] followed by those with eGFR < 35.32 ml/min/1.73 m2, hemoglobin < 11.95 g/dL and SPMSQ < 5 (HR:3.65; 95%CI: 2.21–6.02) and those with
eGFR 35.32–47.99 ml/min/1.73 m2 and sarcopenia (HR:3.65; 95%CI: 1.99–6.69). Survival tree leaf node membership had
good accuracy in predicting the study outcome (C-index: 0.73, 95%CI:0.70-0.76).
Conclusions
Interactions among study risk factors designed distinct risk profiles in older patients
discharged from acute care hospitals, that may help identify patients needing targeted
interventions and appropriate follow-up after discharge.
Keywords
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Article info
Publication history
Published online: July 10, 2021
Accepted:
June 29,
2021
Received in revised form:
June 1,
2021
Received:
February 22,
2021
Identification
Copyright
© 2021 Published by Elsevier B.V. on behalf of European Federation of Internal Medicine.
