Outcomes and Predictors of In-Hospital Mortality among Older Patients with Dementia

Giuseppe De Matteis; Maria Livia Burzo; Davide Antonio Della Polla; Amato Serra; Andrea Russo; Francesco Landi; Antonio Gasbarrini; Giovanni Gambassi; Francesco Franceschi; Marcello Covino

doi:10.3390/jcm12010059

Outcomes and Predictors of In-Hospital Mortality among Older Patients with Dementia

J Clin Med. 2022 Dec 21;12(1):59. doi: 10.3390/jcm12010059.

Authors

Giuseppe De Matteis¹, Maria Livia Burzo², Davide Antonio Della Polla³, Amato Serra⁴, Andrea Russo⁵, Francesco Landi^{4

5}, Antonio Gasbarrini^{4

6}, Giovanni Gambassi^{1

6}, Francesco Franceschi^{3

4}, Marcello Covino^{3

4}

Affiliations

¹ Department of Internal Medicine, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, 00168 Rome, Italy.
² Department of Internal Medicine, Ospedale Santo Spirito in Sassia, 00193 Rome, Italy.
³ Emergency Department, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, 00168 Rome, Italy.
⁴ School of Medicine, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy.
⁵ Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, 00168 Rome, Italy.
⁶ Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.

Abstract

Dementia is associated with high rates of admission to hospital, due to acute illness, and in-hospital mortality. The study aimed to investigate the impact of dementia on in-hospital mortality and identify the predictors of in-hospital mortality in these patients. This was a retrospective study evaluating all the patients ≥65 years consecutively admitted to our Emergency Department (ED). We compared the clinical outcomes of the patients with dementia at ED admission with those who did not have dementia, using a propensity score-matched (PSM) paired cohort of controls. The patients were matched for age, sex, Charlson Comorbidity Index value, and clinical severity at presentation (based on NEWS ≥ 5). The primary study endpoint was all-cause in-hospital death. After the PSM, a total of 7118 patients, 3559 with dementia and 3559 in the control group, were included in the study cohort. The mean age was 84 years, and 59.8% were females. The overall mortality rate was higher for the demented patients compared with the controls (18.7% vs. 16.0%, p = 0.002). The multivariate-adjusted hazard ratio (HR) showed that dementia was an independent risk factor for death (HR 1.13 [1.01−1.27]; p = 0.033). In the patients with dementia, respiratory failure (HR 3.08 [2.6−3.65]), acute renal failure (HR 1.64 [1.33−2.02]; p < 0.001), hemorrhagic stroke (HR 1.84 [1.38−2.44]; p < 0.001), and bloodstream infection (HR 1.41 [1.17−1.71]; p = 0.001) were significant predictors of worse outcomes. Finally, the comorbidities and severity of illness at ED admission negatively influenced survival among the patients with dementia (CCI HR 1.05 [1.01−1.1] p = 0.005; NEWS ≥ 5 HR 2.45 [1.88−3.2] p < 0.001). In conclusion, among the hospitalized older patients, dementia was associated with a higher risk of mortality. Furthermore, among the older patients with dementia, respiratory failure and bloodstream infections were independently associated with an increased risk of in-hospital mortality.

Keywords: dementia; mortality; older patients; respiratory failure; sepsis.

Grants and funding

This research received no external funding.