Prognostic value of estimated glomerular filtration rate in hospitalized elderly patients

Laura De La Higuera, Emma Riva, Codjo Djignefa Djade, Sara Mandelli, Carlotta Franchi, Alessandra Marengoni, Francesco Salerno, Salvatore Corrao, Luca Pasina, Mauro Tettamanti, Maura Marcucci, Pier Mannuccio Mannucci, Alessandro Nobili

Research output: Contribution to journalArticle

Abstract

A multicenter observational study, REPOSI (REgistro POliterapie Società Italiana di Medicina Interna), was conducted to assess the prognostic value of glomerular filtration rate (eGFR) on in-hospital mortality, hospital re-admission and death within 3 months, in a sample of elderly patients (n = 1,363) admitted to 66 internal medicine and geriatric wards. Based on eGFR, calculated by the new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula, subjects at hospital admission were classified into three groups: group 1 with normal eGFR (≥60 ml/min/1.73 m2, reference group), group 2 with moderately reduced eGFR (30–59 ml/min/1.73 m2) and group 3 with severely reduced eGFR (2). Patients with the lowest eGFR (group 3) on admission were more likely to be older, to have a greater cognitive and functional impairment and a high rate of comorbidities. Multivariable logistic regression analysis showed that severely reduced eGFR at the time of admission was associated with in-hospital mortality (OR 3.00; 95 % CI 1.20–7.39, p = 0.0230), but not with re-hospitalization (OR 0.97; 95 % CI 0.54–1.76, p = 0.9156) or mortality at 3 months after discharge (OR 1.93; 95 % CI 0.92–4.04, p = 0.1582). On the contrary, an increased risk (OR 2.60; 95 % CI 1.13–5.98, p = 0.0813) to die within 3 months after discharge was associated with decreased eGFR measured at the time of discharge. Our study demonstrates that severely reduced eGFRs in elderly patients admitted to hospital are strong predictors of the risk of dying during hospitalization, and that this measurement at the time of discharge helps to predict early death after hospitalization.

Original languageEnglish
Pages (from-to)735-747
Number of pages13
JournalInternal and Emergency Medicine
Volume9
Issue number7
DOIs
Publication statusPublished - Oct 2 2014

Fingerprint

Glomerular Filtration Rate
Hospitalization
Hospital Mortality
Internal Medicine
Chronic Renal Insufficiency
Geriatrics
Multicenter Studies
Observational Studies
Comorbidity
Epidemiology
Logistic Models
Regression Analysis
Mortality

Keywords

  • Comorbidity
  • eGFR
  • In-hospital elderly patients
  • Multicenter study
  • Polypharmacy

ASJC Scopus subject areas

  • Emergency Medicine
  • Internal Medicine

Cite this

Prognostic value of estimated glomerular filtration rate in hospitalized elderly patients. / De La Higuera, Laura; Riva, Emma; Djade, Codjo Djignefa; Mandelli, Sara; Franchi, Carlotta; Marengoni, Alessandra; Salerno, Francesco; Corrao, Salvatore; Pasina, Luca; Tettamanti, Mauro; Marcucci, Maura; Mannucci, Pier Mannuccio; Nobili, Alessandro.

In: Internal and Emergency Medicine, Vol. 9, No. 7, 02.10.2014, p. 735-747.

Research output: Contribution to journalArticle

De La Higuera, Laura ; Riva, Emma ; Djade, Codjo Djignefa ; Mandelli, Sara ; Franchi, Carlotta ; Marengoni, Alessandra ; Salerno, Francesco ; Corrao, Salvatore ; Pasina, Luca ; Tettamanti, Mauro ; Marcucci, Maura ; Mannucci, Pier Mannuccio ; Nobili, Alessandro. / Prognostic value of estimated glomerular filtration rate in hospitalized elderly patients. In: Internal and Emergency Medicine. 2014 ; Vol. 9, No. 7. pp. 735-747.
@article{eb3bb358fa67472986f4c1f844586415,
title = "Prognostic value of estimated glomerular filtration rate in hospitalized elderly patients",
abstract = "A multicenter observational study, REPOSI (REgistro POliterapie Societ{\`a} Italiana di Medicina Interna), was conducted to assess the prognostic value of glomerular filtration rate (eGFR) on in-hospital mortality, hospital re-admission and death within 3 months, in a sample of elderly patients (n = 1,363) admitted to 66 internal medicine and geriatric wards. Based on eGFR, calculated by the new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula, subjects at hospital admission were classified into three groups: group 1 with normal eGFR (≥60 ml/min/1.73 m2, reference group), group 2 with moderately reduced eGFR (30–59 ml/min/1.73 m2) and group 3 with severely reduced eGFR (2). Patients with the lowest eGFR (group 3) on admission were more likely to be older, to have a greater cognitive and functional impairment and a high rate of comorbidities. Multivariable logistic regression analysis showed that severely reduced eGFR at the time of admission was associated with in-hospital mortality (OR 3.00; 95 {\%} CI 1.20–7.39, p = 0.0230), but not with re-hospitalization (OR 0.97; 95 {\%} CI 0.54–1.76, p = 0.9156) or mortality at 3 months after discharge (OR 1.93; 95 {\%} CI 0.92–4.04, p = 0.1582). On the contrary, an increased risk (OR 2.60; 95 {\%} CI 1.13–5.98, p = 0.0813) to die within 3 months after discharge was associated with decreased eGFR measured at the time of discharge. Our study demonstrates that severely reduced eGFRs in elderly patients admitted to hospital are strong predictors of the risk of dying during hospitalization, and that this measurement at the time of discharge helps to predict early death after hospitalization.",
keywords = "Comorbidity, eGFR, In-hospital elderly patients, Multicenter study, Polypharmacy",
author = "{De La Higuera}, Laura and Emma Riva and Djade, {Codjo Djignefa} and Sara Mandelli and Carlotta Franchi and Alessandra Marengoni and Francesco Salerno and Salvatore Corrao and Luca Pasina and Mauro Tettamanti and Maura Marcucci and Mannucci, {Pier Mannuccio} and Alessandro Nobili",
year = "2014",
month = "10",
day = "2",
doi = "10.1007/s11739-013-1028-5",
language = "English",
volume = "9",
pages = "735--747",
journal = "Internal and Emergency Medicine",
issn = "1828-0447",
publisher = "Springer-Verlag Italia s.r.l.",
number = "7",

}

TY - JOUR

T1 - Prognostic value of estimated glomerular filtration rate in hospitalized elderly patients

AU - De La Higuera, Laura

AU - Riva, Emma

AU - Djade, Codjo Djignefa

AU - Mandelli, Sara

AU - Franchi, Carlotta

AU - Marengoni, Alessandra

AU - Salerno, Francesco

AU - Corrao, Salvatore

AU - Pasina, Luca

AU - Tettamanti, Mauro

AU - Marcucci, Maura

AU - Mannucci, Pier Mannuccio

AU - Nobili, Alessandro

PY - 2014/10/2

Y1 - 2014/10/2

N2 - A multicenter observational study, REPOSI (REgistro POliterapie Società Italiana di Medicina Interna), was conducted to assess the prognostic value of glomerular filtration rate (eGFR) on in-hospital mortality, hospital re-admission and death within 3 months, in a sample of elderly patients (n = 1,363) admitted to 66 internal medicine and geriatric wards. Based on eGFR, calculated by the new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula, subjects at hospital admission were classified into three groups: group 1 with normal eGFR (≥60 ml/min/1.73 m2, reference group), group 2 with moderately reduced eGFR (30–59 ml/min/1.73 m2) and group 3 with severely reduced eGFR (2). Patients with the lowest eGFR (group 3) on admission were more likely to be older, to have a greater cognitive and functional impairment and a high rate of comorbidities. Multivariable logistic regression analysis showed that severely reduced eGFR at the time of admission was associated with in-hospital mortality (OR 3.00; 95 % CI 1.20–7.39, p = 0.0230), but not with re-hospitalization (OR 0.97; 95 % CI 0.54–1.76, p = 0.9156) or mortality at 3 months after discharge (OR 1.93; 95 % CI 0.92–4.04, p = 0.1582). On the contrary, an increased risk (OR 2.60; 95 % CI 1.13–5.98, p = 0.0813) to die within 3 months after discharge was associated with decreased eGFR measured at the time of discharge. Our study demonstrates that severely reduced eGFRs in elderly patients admitted to hospital are strong predictors of the risk of dying during hospitalization, and that this measurement at the time of discharge helps to predict early death after hospitalization.

AB - A multicenter observational study, REPOSI (REgistro POliterapie Società Italiana di Medicina Interna), was conducted to assess the prognostic value of glomerular filtration rate (eGFR) on in-hospital mortality, hospital re-admission and death within 3 months, in a sample of elderly patients (n = 1,363) admitted to 66 internal medicine and geriatric wards. Based on eGFR, calculated by the new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula, subjects at hospital admission were classified into three groups: group 1 with normal eGFR (≥60 ml/min/1.73 m2, reference group), group 2 with moderately reduced eGFR (30–59 ml/min/1.73 m2) and group 3 with severely reduced eGFR (2). Patients with the lowest eGFR (group 3) on admission were more likely to be older, to have a greater cognitive and functional impairment and a high rate of comorbidities. Multivariable logistic regression analysis showed that severely reduced eGFR at the time of admission was associated with in-hospital mortality (OR 3.00; 95 % CI 1.20–7.39, p = 0.0230), but not with re-hospitalization (OR 0.97; 95 % CI 0.54–1.76, p = 0.9156) or mortality at 3 months after discharge (OR 1.93; 95 % CI 0.92–4.04, p = 0.1582). On the contrary, an increased risk (OR 2.60; 95 % CI 1.13–5.98, p = 0.0813) to die within 3 months after discharge was associated with decreased eGFR measured at the time of discharge. Our study demonstrates that severely reduced eGFRs in elderly patients admitted to hospital are strong predictors of the risk of dying during hospitalization, and that this measurement at the time of discharge helps to predict early death after hospitalization.

KW - Comorbidity

KW - eGFR

KW - In-hospital elderly patients

KW - Multicenter study

KW - Polypharmacy

UR - http://www.scopus.com/inward/record.url?scp=84918842140&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84918842140&partnerID=8YFLogxK

U2 - 10.1007/s11739-013-1028-5

DO - 10.1007/s11739-013-1028-5

M3 - Article

C2 - 24338497

AN - SCOPUS:84918842140

VL - 9

SP - 735

EP - 747

JO - Internal and Emergency Medicine

JF - Internal and Emergency Medicine

SN - 1828-0447

IS - 7

ER -