• R A Incalzi, O Capparella, A Gemma, F Landi, E Bruno, F Di Meo, and P Carbonin.
• Istituto di Medicina Interna e Geriatria dell' Università Cattolica del Sacro Cuore, Rome, Italy.
• J. Intern. Med. 1997 Oct 1; 242 (4): 291-8.

ObjectiveTo test the predictive power of comorbidity and of the interaction between age and comorbidity in geriatric patients with acute medical illness.DesignProspective observational study.SettingMedical and geriatric wards of an acute-care hospital.SubjectsThree hundred and seventy patients over 70 years of age consecutively admitted in an 18-month period.Main Outcome MeasureIn-hospital mortality.MethodOn admission a multidimensional assessment was performed, and a comorbidity index and an age-comorbidity index developed on a comparable training population were calculated. The comorbidity index is based upon a scoring system that quantifies the prognostic weight of individual diseases, while the age-comorbidity index corrects the former for the age-related increase of the risk of death. The predictive power of variables univariately correlated with the outcome was tested by logistic regression.ResultsDeath was independently predicted by clinical diagnosis of malnutrition (odds ratio = 1.87, confidence limits CL = 1.20-2.86), age-comorbidity index > 7 (odds ratio = 1.77, CL = 1.15-2.72), preadmission impairment in activities of daily living (odds ratio = 1.74, CL = 1.13-2.69), lymphocytopenia (odds ratio = 1.74, CL = 1.15-2.61). A weaker predictive model was obtained by substituting the comorbidity index for the index of age-comorbidity. Excluding comorbidity from the logistic regression greatly weakened the predictive model.

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