Predictors of 1-year drug-related admissions in older multimorbid hospitalized adults

Carole E. Aubert*, Nicolas Rodondi, Seraina Netzer, Olivia Dalleur, Anne Spinewine, Clara Drenth van Maanen, Wilma Knol, Denis O'Mahony, Drahomir Aujesky, Jacques Donzé

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Background: Identifying patients at high risk of drug-related hospital admission (DRA) may help to efficiently target preventive interventions. We developed a score to predict DRAs in older patients with multimorbidity and polypharmacy. Methods: We used participants from the multicenter European OPERAM trial (“Optimising PharmacothERapy in the Mutlimorbid Elderly”). We assessed the association between easily identifiable predictors and 1-year DRAs by univariable logistic regression. Variables with p-value< 0.20 were taken forward to backward regression. We retained all variables with p < 0.05 in the model. We assessed the C-statistic, calibration (observed/predicted proportions), and overall accuracy (scaled Brier score, <0.25 indicating a useful model) of the score, and internally validated it by tenfold cross-validation. Results: Within 1 year, 435/1879 (23.2%) patients (mean age 79.4 years) had a DRA. The score included seven variables: previous hospitalizations, non-elective admission, hypertension, cirrhosis with portal hypertension, chronic kidney disease, diuretic, oral corticosteroid. The C-statistic was 0.64 (95% CI 0.61–0.67). Patients with <1 point had a 12.4% predicted and observed risk of DRA, while those with >3 points had a 40.4% predicted and 38.9% observed risk of DRA. The scaled Brier score was 0.05. Calibration showed an adequate match between predicted and observed proportions. Conclusion: Comorbidities related to drug metabolism, specific medications, non-elective admission, and a history of hospitalization, were associated with a higher risk of DRA. Awareness of these associations and the score we developed may help identify patients most likely to benefit from preventive interventions.

Original languageEnglish
Pages (from-to)1510-1516
Number of pages7
JournalJournal of the American Geriatrics Society
Volume70
Issue number5
DOIs
Publication statusPublished - May 2022

Keywords

  • drug-related admission
  • older adult
  • readmission
  • score

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