[Red cell distribution width and mortality following hospital discharge in patients over 70 years of age]. / Ancho de distribución eritrocitario como predictor de mortalidad tras el alta hospitalaria en mayores de 70 años.

BACKGROUND AND OBJECTIVE: To examine whether red cell distribution width (RDW) performs as a mortality predictor after hospital discharge in patients over 70 years of age and if its prognostic power is superior to other laboratory parameters. PATIENTS AND METHODS: Longitudinal and prospective study of 426 patients admitted to the Internal Medicine Department who survived hospitalization. Sociodemographic and comorbidity factors, functional and cognitive status as well as disease parameters causing admission (diagnosis, analytical parameters, length of stay) were collected. Patients were followed for one year by telephone interview and data were collected regarding vital status and, if appropriate, death date. RDW effect on mortality was assessed using logistic regression and prognostic capability by the area under the ROC curve. RESULTS: Each percentage point rise in RDW was associated with increased mortality at one year with an odds ratio of 1.19 (95% confidence interval [95% CI] 1.08 to 1.31). Mortality in each tertile of RDW was 15.6% in the lowest, 21.5% in the middle and 30.5% in the highest. A clinical model supplemented with RDW improved mortality predictive ability assessed by ROC curve. Net reclassification improvement of the prediction rule was 1.71% (95% CI 0.07 to 3.35) p=0.04. CONCLUSION: This study provides new evidence of the RDW association with mortality in a cohort of elderly patients who survived hospitalization. RDW was the only laboratory parameter that improved the one-year prognostic mortality ability.

Place of residence before hospital admission and mortality at 12-months in Spanish patients aged 70 years or older.

AIM: Hospitalization of elderly people is often followed by high mortality rates. The aim of this study was to analyze the influence of prior residence on 1-year mortality after hospital discharge in patients aged 70 years and over. METHODS: This was a prospective observational cohort study. Participants were 426 patients discharged from the Internal Medicine Department at a Spanish Hospital who were followed for a 12-month period. Data collection was carried out during hospitalization and included sociodemographic characteristics, comorbidity (Charlson index), functional (Barthel index and Lawton scale) and cognitive conditions (Short Portable Mental Status Questionnaire), together with parameters related to the disease causing admission (diagnosis related group, laboratory tests, length of hospital stay). Mortality was carried out using telephone interviews. RESULTS: A total of 420 (98.6%) patients were located at the end of follow up. Of these, 95 patients had died, giving an overall 1-year mortality of 22.6%. The mortality rate for patients living in their private homes was 15.6% versus 24.7% for those living with relatives and 60% for those living in institutions. After adjustment for potential confounders, prior residence was associated with mortality with a hazard ratio of 3.98 (95% CI 1.94-8.17) for those institutionalized and a hazard ration of 1.68 (95% CI 0.99-2.16) for those living with relatives, as compared with patients living in their private homes. CONCLUSIONS: Prior residence is associated with 1-year-mortality following discharge after controlling for several multidimensional factors.