Integrated Risk Stratification Using Comorbidity Burden, Frailty, and Systemic Inflammation to Predict 30-Day Mortality in Older Emergency Department Patients: A Prospective Cohort Study
In brief
Three-factor model reached 0.79 AUC for 30-day mortality in older ED patients
Among 326 older emergency patients, 18% died within 30 days. A model combining comorbidity, frailty and inflammation distinguished survivors from those who died better than any factor alone, with an area under the curve of 0.793 and similar performance after internal validation. Its added value over some two-factor models was modest and not statistically significant, so external validation is still needed.
- Journal
- Journal of clinical medicine (Q1)
- Published
- 8 September 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Kamil Konur, Nurullah Parca, Bunyamin Onur Harmanci, Gulfidan Atan, Kadir Can Kamaci, Metin Yildiztac, et al.
- PMID
- 42795727
- DOI
- 10.3390/jcm15186954
Why clinicians should know about it
- Picked for Internal Medicine (paper of the day, 29 September 2026): Integrated comorbidity, frailty, inflammation mortality model for older ED patients
Abstract
Background/Objectives: Estimating mortality risk in older adults presenting to the emergency department (ED) is challenging because risk is shaped by comorbidity burden, frailty, and systemic inflammation. We examined the individual and combined prognostic contributions of the Age-adjusted Charlson Comorbidity Index (CCI), the Clinical Frailty Scale (CFS), and the Systemic Immune-Inflammation Index (SII) to 30-day mortality. Methods: This prospective observational cohort included 326 adults aged ≥65 years evaluated in a tertiary ED from September 2025 through April 2026. CCI, CFS, and SII were assessed at admission, with SII analyzed after logarithmic transformation [ln(SII)]. Associations with 30-day mortality were examined using logistic regression. Discriminative performance was evaluated by receiver operating characteristic analysis, and the integrated model underwent bootstrap internal validation and calibration assessment. Results: Thirty-day mortality occurred in 60 patients (18.4%). CCI, CFS, and ln(SII) were each independently associated with mortality in the integrated multivariable model (all p < 0.05). Individual AUCs were 0.741 for CCI, 0.703 for CFS, and 0.662 for ln(SII), with CCI showing the highest value. The integrated model achieved the highest observed discrimination (AUC 0.793; optimism-corrected AUC 0.783) and showed acceptable internal calibration (Brier score 0.127; bootstrap-corrected calibration intercept 0.003; calibration slope 0.957). Conclusions: Comorbidity burden, frailty, and systemic inflammation each provided independent prognostic information for 30-day mortality in older ED patients. Although CCI was the strongest individual predictor, the integrated model achieved the highest observed discrimination. However, its incremental benefit over some two-predictor models was modest and not statistically significant.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.