The Hospital-patient One-year Mortality Risk Score Accurately Predicted Long-Term Death Risk in Hospitalized Patients

J Clin Epidemiol. 2014 Sep;67(9):1025-34. doi: 10.1016/j.jclinepi.2014.05.003. Epub 2014 Jun 25.

Abstract

Objective: Prognostication is difficult in a diverse patient population or when outcomes depend on multiple factors. This study derived and internally validated a model to predict risk of death from any cause within 1 year of admission to hospital.

Study design and setting: The study included all adult Ontarians admitted to nonpsychiatric hospital services in 2011 (n = 640,022) and deterministically linked administrative data to identify 20 patient and admission factors. A split-sample approach was used to derive and internally validate the model.

Results: A total of 75,082 people (11.7%) died within 1 year of admission to hospital. The final model included one dozen patient factors (age, sex, living status, comorbidities, home oxygen status, and number of emergency room visits and hospital admissions by ambulance in previous year) and hospitalization factors (admission service and urgency, admission to intensive care unit, whether current hospitalization was a readmission, and admission diagnostic risk score). The model in the validation cohort was highly discriminative (c-statistic 92.3), well calibrated, and used to create the Hospital-patient One-year Mortality Risk score that accurately predicted 1-year risk of death.

Conclusion: Routinely collected administrative data can be used to accurately predict 1-year death risk in adults admitted to nonpsychiatric hospital services.

Keywords: Administrative data; Calibration; Discrimination; Hospitalization; Mortality; Multivariable logistic regression; Risk index; Risk model; Risk score; Survival.

MeSH terms

  • Aged, 80 and over
  • Comorbidity
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Hospital Mortality*
  • Hospitalization / statistics & numerical data
  • Humans
  • Inpatients / statistics & numerical data
  • Intensive Care Units
  • Male
  • Models, Statistical*
  • Ontario / epidemiology
  • Palliative Care
  • Risk