Antonio Brucato1, Alberto Ferrari2, Mara Tiraboschi3, Alberto Zucchi4, Chiara Cogliati5, Daniela Torzillo5, Francesco Dentali6, Luca Tavecchia6, Vera Gessi6, Alessandro Squizzato6, Sara Moretti6, Eleonora Tamborini Permunian6, Alessandra Carobbio7, Luca Pasina8, Fabio De Stefano3, Enrico Tombetti9, Davide Cumetti3, Gianni Tognoni10, Tiziano Barbui11. 1. Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi d Milano, Ospedale Fatebenefratelli, Italy; Ospedale Papa Giovanni XXIII, Bergamo, Italy. Electronic address: antonio.brucato@unimi.it. 2. Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy. Electronic address: aferrari@fondazionefrom.it. 3. Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi d Milano, Ospedale Fatebenefratelli, Italy. 4. Epidemiology Unit, Health Protection Agency, Bergamo, Italy. 5. Internal Medicine Department, L. Sacco Hospital, ASST fbf-sacco, Milan, Italy. 6. Department of Medicine and Surgery, University of Insubria, Varese, Italy. 7. Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy. 8. Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy. 9. Ospedale Papa Giovanni XXIII, Bergamo, Italy. 10. Dipartimento di Anestesia-Rianimazione e Emergenza Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 11. Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy. Electronic address: tbarbui@asst-pg23.it.
Abstract
OBJECTIVE: To predict the 3-months mortality in permanently bedridden medical non-oncologic inpatients. PATIENTS AND METHODS: 2788 consecutive patients admitted in 5 Italian Internal Medicine units from January 2016 through January 2017 were prospectively screened; 644 oncologic patients were excluded; 2144 non-oncologic patients (1021 female) were followed-up for mortality for 6 months. Main outcome was 3-months mortality in permanently bedridden inpatients with at least 2 of: creatinine clearance <35 ml/min; albumin < 2.5 g/dl; at least 2 hospital admissions in the previous 6 months. Advanced dementia and dysphagia were also recorded. RESULTS: Mean age of the 2144 patients was 73.9 (SD, 14.9) years; 374 (17%) were permanently bedridden, 435 (20%) had a creatinine clearance <35 ml/min, 217 (10%) albumin <2,5 g/dl, 112 (5%) at least 2 hospital admissions in the previous 6 months. Seventy-seven (4%) patients were permanently bedridden with at least 2 of the above mentioned items, and 48 of them died within 3 months (62%) (p < 0.001;95% CI 51-73%). Regression coefficients of the variables associated with 3-months mortality in multivariate analysis in 998 patients of unit 1 (training cohort) were used to create a simple score, which was validated in the 1146 patients of the other units (validation cohort) and performed well in predicting the 3-months mortality (https://www.ejcrim.com/beclap/). CONCLUSIONS: Approximately two out of three non-oncologic medical patients permanently bedridden having 2 of the abovementioned items are dead 3 months after index admission; a simple score including bedridden status, creatinine clearance, albumin, dysphagia, age and sex may help discuss management priorities.
OBJECTIVE: To predict the 3-months mortality in permanently bedridden medical non-oncologic inpatients. PATIENTS AND METHODS: 2788 consecutive patients admitted in 5 Italian Internal Medicine units from January 2016 through January 2017 were prospectively screened; 644 oncologic patients were excluded; 2144 non-oncologic patients (1021 female) were followed-up for mortality for 6 months. Main outcome was 3-months mortality in permanently bedridden inpatients with at least 2 of: creatinine clearance <35 ml/min; albumin < 2.5 g/dl; at least 2 hospital admissions in the previous 6 months. Advanced dementia and dysphagia were also recorded. RESULTS: Mean age of the 2144 patients was 73.9 (SD, 14.9) years; 374 (17%) were permanently bedridden, 435 (20%) had a creatinine clearance <35 ml/min, 217 (10%) albumin <2,5 g/dl, 112 (5%) at least 2 hospital admissions in the previous 6 months. Seventy-seven (4%) patients were permanently bedridden with at least 2 of the above mentioned items, and 48 of them died within 3 months (62%) (p < 0.001;95% CI 51-73%). Regression coefficients of the variables associated with 3-months mortality in multivariate analysis in 998 patients of unit 1 (training cohort) were used to create a simple score, which was validated in the 1146 patients of the other units (validation cohort) and performed well in predicting the 3-months mortality (https://www.ejcrim.com/beclap/). CONCLUSIONS: Approximately two out of three non-oncologic medical patients permanently bedridden having 2 of the abovementioned items are dead 3 months after index admission; a simple score including bedridden status, creatinine clearance, albumin, dysphagia, age and sex may help discuss management priorities.