European Journal of Epidemiology

, Volume 23, Issue 12, pp 783–791 | Cite as

Derivation and validation of a mortality-risk index from a cohort of frail elderly patients hospitalised in medical wards via emergencies: the SAFES study

  • M. Dramé
  • J. L. Novella
  • P. O. Lang
  • D. Somme
  • N. Jovenin
  • I. Lanièce
  • P. Couturier
  • D. Heitz
  • J. B. Gauvain
  • T. Voisin
  • B. De Wazières
  • R. Gonthier
  • J. Ankri
  • C. Jeandel
  • O. Saint-Jean
  • F. Blanchard
  • D. JollyEmail author


To identify predictive factors for 2-year mortality in frail elderly patients after acute hospitalisation, and from these to derive and validate a Mortality Risk Index (MRI). A prospective cohort of elderly patients was set up in nine teaching hospitals. This cohort was randomly split up into a derivation cohort (DC) of 870 subjects and a validation cohort (VC) of 436 subjects. Data obtained from a Comprehensive Geriatric Assessment were used in a Cox model to predict 2-year mortality and to identify risk groups for mortality. A ROC analysis was performed to explore the validity of the MRI. Five factors were identified and weighted using hazard ratios to construct the MRI: age 85 or over (1 point), dependence for the ADL (1 point), delirium (2 points), malnutrition risk (2 points), and co-morbidity level (2 points for medium level, 3 points for high level). Three risk groups were identified according to the MRI. Mortality rates increased significantly across risk groups in both cohorts. In the DC, mortality rates were: 20.8% in the low-risk group, 49.6% in the medium-risk group, and 62.1% in the high-risk group. In the VC, mortality rates were respectively 21.7, 48.5, and 65.4%. The area under the ROC curve for overall score was statistically the same in the DC (0.72) as in the VC (0.71). The proposed MRI appears as a simple and easy-to-use tool developed from relevant geriatric variables. Its accuracy is good and the validation procedure gives a good stability of results.


Mortality Survival Risk score Prediction Validation SAFES cohort 



To sources of funding: The French Ministry of Health, funding the Clinical Research Hospital Projects (PHRC 1998); The National Health Insurance Agency for Wage Earners–CNAMTS, France; The Institute of Longevity and Ageing–INSERM, France. To Angela Swaine Verdier for her help with the English draft.

Conflicts of interest declaration

The authors each declare no conflict of interest. The financial sponsors played no role in the design, execution, analysis and interpretation of data, or in writing the manuscript.


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Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  • M. Dramé
    • 1
    • 2
  • J. L. Novella
    • 1
    • 2
  • P. O. Lang
    • 1
    • 3
  • D. Somme
    • 4
  • N. Jovenin
    • 1
    • 5
  • I. Lanièce
    • 6
  • P. Couturier
    • 6
  • D. Heitz
    • 7
  • J. B. Gauvain
    • 8
  • T. Voisin
    • 9
  • B. De Wazières
    • 10
  • R. Gonthier
    • 11
  • J. Ankri
    • 12
  • C. Jeandel
    • 13
  • O. Saint-Jean
    • 4
  • F. Blanchard
    • 1
    • 2
  • D. Jolly
    • 1
    • 14
    Email author
  1. 1.Faculty of MedicineUniversity of Reims Champagne-ArdenneReimsFrance
  2. 2.Department of Internal Medicine and Clinical GerontologyReims Teaching Hospitals, Sebastopol HospitalReimsFrance
  3. 3.Department of Rehabilitation and GeriatricsGeneva Medical School and University HospitalsGenevaSwitzerland
  4. 4.Geriatric Department, Public Assistance, Hospitals of ParisGeorges Pompidou European HospitalParisFrance
  5. 5.Department of Medical Information, Methodological Help UnitReims Teaching Hospitals, Maison Blanche HospitalReimsFrance
  6. 6.Geriatrics DepartmentGrenoble Teaching Hospitals, Hospital of La TroncheGrenobleFrance
  7. 7.Department of Internal Medicine and GeriatricsStrasbourg Teaching Hospitals, Hospital of la RobertsauStrasbourgFrance
  8. 8.Geriatrics CentreRegional Hospitals Centre of Orléans, Hospital of Porte MadeleineOrléansFrance
  9. 9.Department of Internal Medicine and Clinical GerontologyToulouse Teaching Hospitals, Rangueil HospitalToulouseFrance
  10. 10.Department of Internal Medicine and GeriatricsNîmes Teaching Hospitals, Gaston Doumergues HospitalNîmesFrance
  11. 11.Department of Clinical GerontologySaint Etienne Teaching Hospitals, Hospital of La CharitéSaint EtienneFrance
  12. 12.Centre of Gerontology, Public AssistanceHospitals of Paris, Saint Perine HospitalParisFrance
  13. 13.Clinical Gerontology CentreMontpellier Teaching Hospitals, Hospital of La ColombièreMontpellierFrance
  14. 14.Department of Clinical Research CoordinationReims Teaching Hospitals, Maison Blanche HospitalReims CedexFrance

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