Background: Short-term prognosis, e.g. mortality at three months, has many important implications in planning the overall management of patients, particularly non-oncologic patients in order to avoid futile practices. The aims of this study were: i) to investigate the risk of three-month mortality after discharge from internal medicine and geriatric wards of non-oncologic patients with at least one of the following conditions: permanent bedridden status during the hospital stay; severely reduced kidney function; hypoalbuminemia; hospital admissions in the previous six months; severe dementia; ii) to establish the absolute risk difference of three-month mortality of bedridden compared to non-bedridden patients. Methods: This prospective cohort study was run in 102 Italian internal medicine and geriatric hospital wards. The sample included all patients with three-months follow-up data. Bedridden condition was defined as the inability to walk or stand upright during the whole hospital stay. The following parameters were also recorded: estimated GFR <= 29 mL/min/1.73 m(2); severe dementia; albuminemia << 2.5 g/dL; hospital admissions in the six months before the index admission. Results: Of 3915 patients eligible for the analysis, three-month follow-up were available for 2058, who were included in the study. Bedridden patients were 112 and the absolute risk difference of mortality at three months was 0.13 (CI 95% 0.08-0.19, p << 0.0001). Logistic regression analysis also adjusted for age, sex, number of drugs and comorbidity index found that bedridden condition (OR 2.10, CI 95% 1.12-3.94), severely reduced kidney function (OR 2.27, CI 95% 1.22-4.21), hospital admission in the previous six months (OR 1.96, CI 95% 1.22-3.14), severe dementia (with total or severe physical dependence) (OR 4.16, CI 95% 2.39-7.25) and hypoalbuminemia (OR 2.47, CI 95% 1.12-5.44) were significantly associated with higher risk of three-month mortality. Conclusions: Bedridden status, severely reduced kidney function, recent hospital admissions, severe dementia and hypoalbuminemia were associated with higher risk of three-month mortality in non-oncologic patients after discharge from internal medicine and geriatric hospital wards.

Risk factors for three-month mortality after discharge in a cohort of non-oncologic hospitalized elderly patients: Results from the REPOSI study

Roberto Manfredini
Membro del Collaboration Group
;
Fabio Fabbian
Membro del Collaboration Group
;
Valeria Raparelli;Roberto De Giorgio
Membro del Collaboration Group
;
2018

Abstract

Background: Short-term prognosis, e.g. mortality at three months, has many important implications in planning the overall management of patients, particularly non-oncologic patients in order to avoid futile practices. The aims of this study were: i) to investigate the risk of three-month mortality after discharge from internal medicine and geriatric wards of non-oncologic patients with at least one of the following conditions: permanent bedridden status during the hospital stay; severely reduced kidney function; hypoalbuminemia; hospital admissions in the previous six months; severe dementia; ii) to establish the absolute risk difference of three-month mortality of bedridden compared to non-bedridden patients. Methods: This prospective cohort study was run in 102 Italian internal medicine and geriatric hospital wards. The sample included all patients with three-months follow-up data. Bedridden condition was defined as the inability to walk or stand upright during the whole hospital stay. The following parameters were also recorded: estimated GFR <= 29 mL/min/1.73 m(2); severe dementia; albuminemia << 2.5 g/dL; hospital admissions in the six months before the index admission. Results: Of 3915 patients eligible for the analysis, three-month follow-up were available for 2058, who were included in the study. Bedridden patients were 112 and the absolute risk difference of mortality at three months was 0.13 (CI 95% 0.08-0.19, p << 0.0001). Logistic regression analysis also adjusted for age, sex, number of drugs and comorbidity index found that bedridden condition (OR 2.10, CI 95% 1.12-3.94), severely reduced kidney function (OR 2.27, CI 95% 1.22-4.21), hospital admission in the previous six months (OR 1.96, CI 95% 1.22-3.14), severe dementia (with total or severe physical dependence) (OR 4.16, CI 95% 2.39-7.25) and hypoalbuminemia (OR 2.47, CI 95% 1.12-5.44) were significantly associated with higher risk of three-month mortality. Conclusions: Bedridden status, severely reduced kidney function, recent hospital admissions, severe dementia and hypoalbuminemia were associated with higher risk of three-month mortality in non-oncologic patients after discharge from internal medicine and geriatric hospital wards.
Pasina, Luca; Cortesi, Laura; Tiraboschi, Mara; Nobili, Alessandro; Lanzo, Giovanna; Tettamanti, Mauro; Franchi, Carlotta; Mannuccio Mannucci, Pier; Ghidoni, Silvia; Assolari, Andrea; Brucato, Antonio; Prisco, Domenico; Silvestri, Elena; Cenci, Caterina; Emmi, Giacomo; Biolo, Gianni; Guarnieri, Gianfranco; Zanetti, Michela; Fernandes, Giovanni; Vanoli, Massimo; Grignani, Giulia; Casella, Gianluca; Bernardi, Mauro; Li Bassi, Silvia; Santi, Luca; Zaccherini, Giacomo; Mannarino, Elmo; Lupattelli, Graziana; Bianconi, Vanessa; Paciullo, Francesco; Nuti, Ranuccio; Valenti, Roberto; Ruvio, Martina; Cappelli, Silvia; Palazzuoli, Alberto; Salvatore, Teresa; Carlo Sasso, Ferdinando; Girelli, Domenico; Olivieri, Oliviero; Matteazzi, Thomas; Barbagallo, Mario; Plances, Lidia; Alcamo, Roberta; Licata, Giuseppe; Calvo, Luigi; Valenti, Maria; Zoli, Marco; Arnò, Raffaella; Laghi Pasini, Franco; Leopoldo Capecchi, Pier; Bicchi, Maurizio; Palasciano, Giuseppe; Ester Modeo, Maria; Peragine, Maria; Pappagallo, Fabrizio; Pugliese, Stefania; Di Gennaro, Carla; Postiglione, Alfredo; Rosaria Barbella, Maria; De Stefano, Francesco; Domenica Cappellini, Maria; Fabio, Giovanna; Seghezzi, Sonia; Migone De Amicis, Margherita; Mari, Daniela; Dionigi Rossi, Paolo; Damanti, Sarah; Brignolo Ottolini, Barbara; Damanti, Sarah; Roberto Corazza, Gino; Miceli, Emanuela; Vincenzo Lenti, Marco; Padula, Donatella; Murialdo, Giovanni; Marra, Alessio; Cattaneo, Federico; Beatrice Secchi, Maria; Ghelfi, Davide; Anastasio, Luigi; Sofia, Lucia; Carbone, Maria; Davì, Giovanni; Teresa Guagnano, Maria; Sestili, Simona; Mancuso, Gerardo; Calipari, Daniela; Bartone, Mosè; Rachele Meroni, Maria; Cavallo Perin, Paolo; Lorenzati, Bartolomeo; Gruden, Gabriella; Bruno, Graziella; Amione, Cristina; Fornengo, Paolo; Tassara, Rodolfo; Melis, Deborah; Rebella, Lara; Delitala, Giuseppe; Pretti, Vincenzo; Salvatora Masala, Maristella; Bolondi, Luigi; Rasciti, Leonardo; Serio, Ilaria; Rossi Fanelli, Filippo; Amoroso, Antonio; Molfino, Alessio; Petrillo, Enrico; Zuccalà, Giuseppe; Franceschi, Francesco; De Marco, Guido; Chiara, Cordischi; Marta, Sabbatini; Romanelli, Giuseppe; Amolini, Claudia; Chiesa, Deborah; Marengoni, Alessandra; Picardi, Antonio; Vespasiani Gentilucci, Umberto; Gallo, Paolo; Annoni, Giorgio; Corsi, Maurizio; Zazzetta, Sara; Bellelli, Giuseppe; Arturi, Franco; Succurro, Elena; Rubino, Mariangela; Sesti, Giorgio; Loria, Paola; Angela Becchi, Maria; Martucci, Gianfranco; Fantuzzi, Alessandra; Maurantonio, Mauro; Delitala, Giuseppe; Carta, Stefano; Atzori, Sebastiana; Grazia Serra, Maria; Antonietta Bleve, Maria; Gasbarrone, Laura; Rosaria Sajeva, Maria; Brucato, Antonio; Ghidoni, Silvia; Di Corato, Paola; Agnelli, Giancarlo; Marchesini, Emanuela; Fabris, Fabrizio; Carlon, Michela; Turatto, Francesca; Baritusso, Aldo; Turatto, Francesca; Manfredini, Roberto; Molino, Christian; Pala, Marco; Fabbian, Fabio; Boari, Benedetta; De Giorgi, Alfredo; Paolisso, Giuseppe; Rosaria Rizzo, Maria; Teresa Laieta, Maria; Rini, Giovanbattista; Mansueto, Pasquale; Pepe, Ilenia; Borghi, Claudio; Strocchi, Enrico; De Sando, Valeria; Sabbà, Carlo; Saverio Vella, Francesco; Suppressa, Patrizia; Valerio, Raffaella; Pugliese, Stefania; Capobianco, Caterina; Fenoglio, Luigi; Bracco, Christian; Valentina Giraudo, Alessia; Testa, Elisa; Serraino, Cristina; Fargion, Silvia; Bonara, Paola; Periti, Giulia; Porzio, Marianna; Peyvandi, Flora; Tedeschi, Alberto; Rossio, Raffaella; Monzani, Valter; Savojardo, Valeria; Folli, Christian; Magnini, Maria; Salerno, Francesco; Conca, Alessio; Gobbo, Giulia; Conca, Alessio; Balduini, Carlo L.; Bertolino, Giampiera; Provini, Stella; Quaglia, Federica; Dallegri, Franco; Ottonello, Luciano; Liberale, Luca; Sheng Chin, Wu; Carassale, Laura; Caporotundo, Silvia; Traisci, Giancarlo; De Feudis, Lucrezia; Di Carlo, Silvia; Lucio Liberato, Nicola; Buratti, Alberto; Tognin, Tiziana; Battista Bianchi, Giovanni; Giaquinto, Sabrina; Purrello, Francesco; Di Pino, Antonino; Piro, Salvatore; Rozzini, Renzo; Falanga, Lina; Montrucchio, Giuseppe; Greco, Elisabetta; Tizzani, Pietro; Petitti, Paolo; Perciccante, Antonio; Coralli, Alessia; Salmi, Raffaella; Gaudenzi, Piergiorgio; Gamberini, Susanna; Semplicini, Andrea; Gottardo, Lucia; Vendemiale, Gianluigi; Serviddio, Gaetano; Forlano, Roberta; Masala, Cesare; Mammarella, Antonio; Raparelli, Valeria; Violi, Francesco; Basili, Stefania; Perri, Ludovica; Landolfi, Raffaele; Montalto, Massimo; Mirijello, Antonio; Vallone, Carla; Bellusci, Martino; Setti, Donatella; Pedrazzoli, Filippo; Guasti, Luigina; Castiglioni, Luana; Maresca, Andrea; Squizzato, Alessandro; Molaro, Marta; Bertolotti, Marco; Mussi, Chiara; Vittoria Libbra, Maria; Miceli, Andrea; Pellegrini, Elisa; Carulli, Lucia; Perticone, Francesco; Sciacqua, Angela; Quero, Michele; Bagnato, Chiara; Corinaldesi, Roberto; DE GIORGIO, Roberto; Serra, Mauro; Grasso, Valentina; Ruggeri, Eugenio; Salvi, Andrea; Leonardi, Roberto; Grassini, Chiara; Mascherona, Ilenia; Minelli, Giorgio; Maltese, Francesca; Gabrielli, Armando; Mattioli, Massimo; Capeci, William; Pio Martino, Giuseppe; Corrao, Salvatore; Messina, Silvia; Ghio, Riccardi; Favorini, Serena; Dal Col, Anna; Minisola, Salvatore; Colangelo, Luciano; Afeltra, Antonella; Alemanno, Pamela; Marigliano, Benedetta; Castellino, Pietro; Blanco, Julien; Zanoli, Luca; Cattaneo, Marco; Fracasso, Paola; Valentina Amoruso, Maria; Saracco, Valter; Fogliati, Marisa; Bussolino, Carlo; Durante, Vittorio; Eusebi, Giovanna; Tirotta, Daniela; Mete, Francesca; Gino, Miriam; Cittadini, Antonio; Arcopinto, Michele; Salzano, Andrea; Bobbio, Emanuele; Maria Marra, Alberto; Sirico, Domenico; Moreo, Guido; Scopelliti, Francesco; Gasparini, Francesca; Cocca, Melissa; Ramirez Duque, Nieves; Muela Molinero, Alberto; Abad Requejo, Pedro; Lopez Pelaez, Vanessa; Tamargo, Lara; Corbella Viros, Xavier; Formiga, Francesc; Diez Manglano, Jesus; Bejarano Tello, Esperanza; Del Corral Behamonte, Esther; Sevil Puras, Maria; Romero, Manuel; Pinilla Llorente, Blanca; Lopez Gonzalez-Cobos, Cristina; Victoria Villalba Garcia, M.; Bosco Lopez Saez, Juan; Sanz Baena, Susana; Arroyo Gallego, Marta; Gonzalez Becerra, Concepcion; Fernandez Moyano, Antonio; Gomez Hernandez, Mercedes; Poyato Borrego, Manuel; Pacheco Cuadros, Raquel; Perez Rojas, Florencia; Garcia Olid, Beatriz; Carrascosa Garcia, Sara; Gonzalez-Cruz Cervellera, Alfonso; Peinado Martinez, Marta; Ruiz Cantero, Alberto; Albarracín Arraigosa, Antonio; Godoy Guerrero, Montserrat; Angel Barón Ramos, Miguel; Manuel Machin, Jose; Novo Veleiro, Ignacio; Alvela Suarez, Lucia; Lopez, Alfonso; Rubal Bran, David; Iñiguez Vazquez, Iria; Prego., Monica Rios
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