RACE AND VERY LOW SERUM CREATININE AS PREDICTORS OF OUTCOMES IN HOSPITALIZED ELDERLY PATIENTS
METHODS: Retrospective cohort study of all hospitalized elderly (age ≥ 65 years) patients admitted in a year. VLSC was defined, a priori, as creatinine ≤ 0.6mg/dl. The primary outcome was in-hospital mortality. Secondary outcomes were ICU transfer, disposition after hospital stay, and recurrent admissions to the hospital within one year of discharge.
RESULTS: 3926 elderly patients, 75.6% White, 58% female, with median age of 79 years were admitted. Analyses were restricted to the 2732 patients with serum creatinine <1.2mg/dl. Of these 12.8% had VLSC and 11% were AA. VLSC was associated with lower albumin levels ( Median 3.0 versus 3.3, p=0.0007 ) and inversely associated with BMI (median 38.3 versus 26.9, p<0.0001). The overall in-hospital mortality was 8.3% (95% CI: 7.3%, 9.4%). Adjusting for age, albumin level, race, and gender, there was nearly a 100% excess mortality among the VLSC group (Adjusted OR 1.99, 95% CI 1.10, 3.63, p=0.02). Much of these excess mortality was explained by higher rates of congestive heart failure in the VLSC group (26.9% versus 14.0%, p<0.0001 ). AA were less likely to be discharged to Extended Care Facilities (ECF) (35.% versus 42.4%, p=0.012) and more likely to be re-admitted (45.1 versus 38.1, p=0.016). There was no statistically significant association between race and mortality or ICU transfer.
CONCLUSIONS: Very low admission serum creatinine is an independent predictor of in-hospital mortality in elderly hospitalized patients. Elderly AA are less likely to be discharged to ECF compared to whites.