Clinical characteristics, frailty, and one-year survival outcomes in centenarian patients presenting to the emergency department

BACKGROUND: Centenarian patients constitute a rapidly growing yet understudied population in emergency medicine. Evidence regarding prognostic factors and one-year outcomes in individuals aged 100 years and older presenting to the emergency department remains limited. METHODS: This retrospective observational study was conducted in the emergency department of Giresun Training and Research Hospital and included centenarian patients presenting between 2010 and 2023. A total of 160 emergency department visits from 83 unique patients were evaluated. Demographic characteristics, clinical variables, comorbidities, frailty indices, and laboratory parameters obtained at admission were recorded. Frailty was assessed using a modified frailty index excluding functional dependence (mFI-4) and the Clinical Frailty Scale (CFS). The primary outcome was one-year all-cause mortality. Kaplan-Meier survival analysis and Cox proportional hazards regression analysis were performed at the patient level using the index emergency department visit. RESULTS: In the descriptive visit-level analysis, non-survivor visits showed higher hospitalization frequency and less favorable inflammatory and renal function marker profiles than survivor visits, while pulmonary diseases were more frequent among non-survivors and cardiovascular diseases were more common among survivors. Modified frailty index scores did not differ significantly between groups. Higher CFS categories were associated with shorter median survival times, although Kaplan-Meier analysis showed no statistically significant separation between frailty categories. In Cox regression analysis, hospitalization at the index emergency department visit and higher blood urea nitrogen levels remained independently associated with one-year mortality. CONCLUSION: In centenarian patients presenting to the emergency department, traditional comorbidity-based frailty indices show limited discriminatory value for one-year mortality. Acute clinical presentation and laboratory parameters reflecting inflammatory burden, renal function, and physiological reserve appear to be more closely associated with outcomes. CLINICAL TRIAL REGISTRATION: The study is not registered in a clinical trial registry.