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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In recent years&#44; the worldwide population has aged&#46; It is estimated that the population older than 65 years will represent 20&#37; of the overall European population by 2025&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> Between 1991 and 2001&#44; the absolute number of individuals aged 90 years or more in Spain doubled&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> This aging of the population will logically lead to an increase in hospitalizations&#44; diagnostic and therapeutic procedures and costs&#46; In 2014&#44; the results were published from the derivation and external validation cohort for a simple prediction rule for hospital mortality in nonagenarian patients&#46; The rule is based on acute disease markers and includes 4 variables collected at admission &#40;1 point per item&#41;&#58; sodium &#40;&#62;145<span class="elsevierStyleHsp" style=""></span>mEq&#47;L&#41; and urea &#40;&#62;84<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41; concentrations in blood&#44; respiratory rate &#40;&#62;20<span class="elsevierStyleHsp" style=""></span>bpm&#41; and shock index &#40;heart rate&#47;systolic blood pressure &#62;1&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> These variables&#44; applied to elderly patients&#44; constitute the abbreviation NaURSE &#40;<span class="elsevierStyleBold">Na</span><span class="elsevierStyleSup">&#43;</span>&#44; <span class="elsevierStyleBold">U</span>rea&#44; <span class="elsevierStyleBold">R</span>espiratory rate&#44; <span class="elsevierStyleBold">S</span>hock index&#44; <span class="elsevierStyleBold">S</span>enility&#44; <span class="elsevierStyleBold">E</span>lderly&#41;&#46; The endpoint for this study was all-cause death during hospitalization&#46; The rule had an area under the receiver operating characteristic &#40;ROC&#41; curve of 0&#46;69 &#40;95&#37; confidence interval &#91;CI&#93; 0&#46;63&#8211;0&#46;76&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The aim of this study was to validate this rule in a Spanish nonagenarian population&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A retrospective&#44; cross-sectional study was designed to extract all discharges of patients older than 90 years from the department of internal medicine for 2013 from the registry of University Hospital of Donostia &#40;San Sebastian&#44; Spain&#41;&#46; The study analyzed 917 episodes from the 998 obtained&#44; due to the loss of a number of the critical variables at admission&#46; This resulted in a loss rate of 8&#37;&#46; The study cohort&#39;s mean age was 92&#46;5 years &#40;standard deviation&#44; 2&#46;7&#41;&#46; The mortality rate was 13&#46;6&#37; and increased according to the risk levels predicted by the rule &#40;0&#8211;4 points&#41;&#58; 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A number of studies<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> have shown that classic prognostic factors such as age&#44; comorbidity and dependence are not associated with mortality&#46; In the case of acute disease markers &#40;blood pressure&#44; heart rate&#44; etc&#46;&#41;&#44; the results have been mixed&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">5&#44;6</span></a> Furthermore&#44; a number of models have limited practical applicability due to their complexity&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> Reproducible predictors are therefore difficult to find&#44; which is probably due to the significant heterogeneity in these patients&#8217; physical&#44; psychological and social situation&#46; Specific patient subgroups therefore need to be identified to better define the prediction models&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion&#44; the application of the NaURSE rule to a local population older than 90 years confirmed its modest capacity for predicting mortality in hospitalized patients&#46; The rule&#39;s performance increases dramatically in patients with higher scores&#44; which could help adjust the clinical decisions and therapeutic effort for patients with a higher probability of death in the immediate term&#46; Even so&#44; this rule should not substitute clinical judgment based on an individual assessment of each patient&#46;</p></span>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">NaURSE score&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">NPV &#37; &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Crude accuracy rate &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#62;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">88&#46;0 &#40;81&#46;0&#8211;93&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;7 &#40;21&#46;8&#8211;27&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;6 &#40;13&#46;0&#8211;18&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92&#46;9 &#40;88&#46;5&#8211;96&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#62;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&#46;4 &#40;33&#46;6&#8211;51&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79&#46;7 &#40;76&#46;7&#8211;82&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;8 &#40;19&#46;1&#8211;31&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89&#46;8 &#40;87&#46;3&#8211;91&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#62;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;8 &#40;10&#46;7&#8211;24&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">97&#46;4 &#40;96&#46;0&#8211;98&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#46;0 &#40;34&#46;2&#8211;65&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">88&#46;1 &#40;85&#46;8&#8211;90&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">86&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#62;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;2 &#40;0&#46;9&#8211;8&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">99&#46;8 &#40;99&#46;3&#8211;100&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80 &#40;28&#46;4&#8211;99&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">86&#46;7 &#40;84&#46;4&#8211;88&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">86&#46;7&nbsp;\t\t\t\t\t\t\n
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Journal Information
Vol. 218. Issue 2.
Pages 110-111 (March 2018)
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Vol. 218. Issue 2.
Pages 110-111 (March 2018)
Correspondence
Validation of the NaURSE rule for predicting in-hospital mortality in nonagenarians
Validación externa de la regla NaURSE para predecir mortalidad intrahospitalaria en nonagenarios
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8
N. Péreza,
Corresponding author
, I. Urretab, M. Elolaa, P. Araneguia
a Servicio de Medicina Interna, Hospital Universitario Donostia, Donostia-San Sebastián, Guipúzcoa, Spain
b Servicio de Epidemiología Clínica, Hospital Universitario Donostia, Donostia-San Sebastián, Guipúzcoa, Spain
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Table 1. Sensitivity, specificity, likelihood ratios, predictive values and crude accuracy rate for mortality of the NaURSE rule in the study population.

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