The prognostic value of admission vital signs, peripheral edema, ECG abnormalities, and orthostatic hypotension in ageing patients admitted to a medical department

Background: The global population is ageing, increasing the burden on medical services. Elderly patients often present with atypical symptoms and complex comorbidities. The combined prognostic value of initial clinical findings upon admission remains underexplored in local tertiary care settings.
Objective: To evaluate the association between initial clinical findings (vital sign instability, pedal edema, ECG abnormalities, and orthostatic hypotension) and in-hospital outcomes among ageing patients admitted to the medical department at King Hussein Medical Center.
Methods: A retrospective cohort study was conducted on 418 patients aged ≥60 years admitted between January 2022 and January 2025. Data collected included demographics, admission vital signs, peripheral edema, ECG findings, and orthostatic hypotension. The primary outcome was a composite of in-hospital mortality, length of stay >7 days, and discharge to increased care. Multivariate regression analysis identified independent predictors.
Results: Mean age was 72.4±8.6 years; 54.3% male. The composite adverse outcome occurred in 58.4% (n=244). Independent predictors were: orthostatic hypotension (aOR=3.24, 95% CI: 2.08–5.05, p<0.001), ECG abnormalities (aOR=2.18, 95% CI: 1.45–3.28, p<0.001), pedal edema (aOR=1.85, 95% CI: 1.22–2.80, p=0.004), tachycardia >100 bpm (aOR=1.72, 95% CI: 1.12–2.64, p=0.013), and hypotension (SBP <100 mmHg) (aOR=1.68, 95% CI: 1.08–2.61, p=0.021). Presence of ≥2 abnormalities increased risk substantially (aOR=4.56, 95% CI: 2.84–7.32, p<0.001). In-hospital mortality was 8.6%, highest in patients with orthostatic hypotension (14.2%) and ECG abnormalities (11.8%).
Conclusion: Simple admission clinical findings particularly orthostatic hypotension, ECG abnormalities, pedal edema, and vital sign instability are independently associated with adverse in-hospital outcomes in ageing patients. These readily available parameters should guide early risk stratification.