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Multicenter Study
. 2022 May;70(5):1510-1516.
doi: 10.1111/jgs.17667. Epub 2022 Jan 22.

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

Carole E Aubert  1   2 , Nicolas Rodondi  1   2 , Seraina Netzer  1   2 , Olivia Dalleur  3   4 , Anne Spinewine  3   5 , Clara Drenth-van Maanen  6 , Wilma Knol  6 , Denis O'Mahony  7   8 , Drahomir Aujesky  1 , Jacques Donzé  9   10   11
Affiliations
Multicenter Study

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

Carole E Aubert et al. J Am Geriatr Soc. 2022 May.

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.

Keywords: drug-related admission; older adult; readmission; score.

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Conflict of interest statement

The author declares that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Figures

FIGURE 1
FIGURE 1
Calibration of the score to predict 1‐year drug‐related admissions. N, number of patients. Predicted versus observed drug‐related admissions at 1 year after discharge according to a) risk category; 2) score points. Score ranged from −3 to 9 points (for a maximum of 12 points). Point categories with <5% of patients were merged. Lower risk was defined as <3 points, and higher risk as ≥3 points, corresponding to the upper quartile
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