Key result
The HOSPITAL score and LACE index demonstrated similar, moderate discrimination (C-statistic 0.69) and good overall accuracy for predicting 1-year mortality in hospitalized older multimorbid patients.
Why the study?
Existing mortality prediction models often require data not immediately available during routine clinical care, but the HOSPITAL score and LACE index may also predict mortality in hospitalized older multimorbid patients.
Do the HOSPITAL score and LACE index accurately predict 1-year and 30-day mortality in hospitalized older multimorbid patients with polypharmacy?
Observational (n=1,879)
Yes
Do the HOSPITAL score and LACE index accurately predict 1-year and 30-day mortality in hospitalized older multimorbid patients with polypharmacy?
Effect estimate: C-statistic 0.69 (95% CI 0.66-0.72)
p-value: p=0.81
The HOSPITAL score and LACE index demonstrate good accuracy and moderate discrimination for predicting 1-year and 30-day mortality in older multimorbid patients, providing simple tools to inform post-hospitalization care intensity.
HOSPITAL and LACE scores may inform mortality risk in older multimorbid inpatients; leaves open routine adoption pending further validation.
BACKGROUND: Estimating life expectancy of older adults informs whether to pursue future investigation and therapy. Several models to predict mortality have been developed but often require data not immediately available during routine clinical care. The HOSPITAL score and the LACE index were previously validated to predict 30-day readmissions but may also help to assess mortality risk. We assessed their performance to predict 1-year and 30-day mortality in hospitalized older multimorbid patients with polypharmacy. METHODS: We calculated the HOSPITAL score and LACE index in patients from the OPERAM (OPtimising thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly) trial (patients aged ≥ 70 years with multimorbidity and polypharmacy, admitted to hospital across four European countries in 2016-2018). Our primary and secondary outcomes were 1-year and 30-day mortality. We assessed the overall accuracy (scaled Brier score, the lower the better), calibration (predicted/observed proportions), and discrimination (C-statistic) of the models. RESULTS: Within 1 year, 375/1879 (20.0%) patients had died, including 94 deaths within 30 days. The overall accuracy was good and similar for both models (scaled Brier score 0.01-0.08). The C-statistics were identical for both models (0.69 for 1-year mortality, p = 0.81; 0.66 for 30-day mortality, p = 0.94). Calibration showed well-matching predicted/observed proportions. CONCLUSION: The HOSPITAL score and LACE index showed similar performance to predict 1-year and 30-day mortality in older multimorbid patients with polypharmacy. Their overall accuracy was good, their discrimination low to moderate, and the calibration good. These simple tools may help predict older multimorbid patients' mortality after hospitalization, which may inform post-hospitalization intensity of care.
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Aubert et al. (2022) conducted an observational in Multimorbidity and polypharmacy in older hospitalized patients (n=1,879). HOSPITAL score and LACE index was evaluated on 1-year all-cause mortality (C-statistic 0.69, 95% CI 0.66-0.72, p=0.81). The HOSPITAL score and LACE index demonstrated similar, moderate discrimination (C-statistic 0.69) and good overall accuracy for predicting 1-year mortality in hospitalized older multimorbid patients.
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