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A Mortality Risk Index for Men in a Veterans Administration Extended Care Facility

Medical Service, Veterans Administration Medical Center, Department of Medicine, University of Health Sciences/The Chicago Medical School, North Chicago, Department of Epidemiology, University of Illinois School of Public Health, Chicago, Illinois

Dale E. Mattson, PH.D.

Medical Service, Veterans Administration Medical Center, Department of Medicine, University of Health Sciences/The Chicago Medical School, North Chicago, Department of Epidemiology, University of Illinois School of Public Health, Chicago, Illinois

Axel G. Feller, M.D.

Medical Service, Veterans Administration Medical Center, Department of Medicine, University of Health Sciences/The Chicago Medical School, North Chicago, Department of Epidemiology, University of Illinois School of Public Health, Chicago, Illinois

Hoskote S. Nagraj, M.D.

Medical Service, Veterans Administration Medical Center, Department of Medicine, University of Health Sciences/The Chicago Medical School, North Chicago, Department of Epidemiology, University of Illinois School of Public Health, Chicago, Illinois

The purpose of this study was to develop (phase I) and validate (phase II) a mortality prognostic index, based on the annual clinical data base, for the men of this Veterans Administration extended care facility.

The study population during phase I consisted of 123 men who were residing in three of the seven wards of the facility in August 1984. Sixty-six of these individuals were institutionalized because of a chronic neurologic (50) or medical (15) disorder ("nonpsychiatric group"). In 57 men, the reason for institutionalization was a chronic psychosis (schizophrenia, 53; manic depressive illness, 4) ("psychiatric group"). During August to October 1984, a comprehensive clinical data base comprising 70 attributes (including diagnoses and drugs) was collected. Deaths were recorded during the next 14 months. Death rate during the 14 months of observation was 33.3% in the nonpsychiatric group, and only 1.7% in the psychiatric group. In the nonpsychiatric men, univariate analysis yielded six attributes significantly correlated with death rate: serum cholesterol level, hematocrit, hemoglobin, midarm muscle circumference, triceps skinfold, and number of morbidity episodes. After serum cholesterol and hematocrit had been entered into a multivariate analysis model, none of the other four attributes contributed significant information about death rate. The multivariate analysis led to a mortality risk index (MRI) for nonpsychiatric patients, MRI = [hematocrit in %] + 10% [serum cholesterol in mg/dl]. As MRI varied from <50 to >65, death rate in the nonpsychiatric group varied in parallel from 86-11%. At the cut-off level MRI = 60, sensitivity was 0.86, specificity was 0.66, positive predictive accuracy was 0.56 and correct classification was 0.73. The odds ratio for the same cut-off level was 12.2.

In phase II, the study population was 116 nonpsychiatric men residing in the remaining four wards of the Extended Care Facility in August 1984. Mortality rate during the 14 months after August 1984 was 31%. The relation of death rate to MRI was generally similar to that observed for the nonpsychiatric men in phase I of the study.

When data of phases I and II were combined and cut-off point of 60 on the MRI was chosen, the odds ratio was 6.45. (Journal of Parenteral and Enteral Nutrition 13 :189-195, 1989)

Journal of Parenteral and Enteral Nutrition, Vol. 13, No. 2, 189-195 (1989)
DOI: 10.1177/0148607189013002189


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