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Background impaired hydration is common in the older people, however studies of its effects on outcome in the acute setting are limited. Objectives to assess (i) the prevalence of impaired hydration, (ii) its relationship with laboratory markers of altered hydration and with (iii) short- and long-term mortality. Design retrospective cohort study. Setting University Hospital-Internal Medicine Department. Subjects a total of 5,113 older patients consecutively acutely admitted from October 2015 to July 2016. Methods according to calculated serum osmolarity at admission hydration status was stratified in: low osmolarity (<275 mmol/L), euhydration (275–295 mmol/L), impending (296–300 mmol/L) and current dehydration (>300 mmol/L). Relationships with serum sodium, potassium, glucose, urea, estimated glomerular filtration rate (eGFR), haematocrit, urea/creatinine ratio (Urea/Cr) and urine specific gravity (USG) were determined. Charlson Comorbidity Index, Modified Early Warning Score, Glasgow Prognostic Score, Norton score and Nutritional Risk Screening-2002 were calculated. Results current and impending dehydration, euhydration and low-osmolarity were detected in 51.7, 17.1, 28.5 and 2.7% of the patients, respectively. Osmolarity correlated with urea (r = 0.846). Associations with serum sodium, creatinine, eGFR and urea/Cr were low but significant, being negligible that with USG and haematocrit. Serum sodium and urea increased in the transition from low- to high-osmolarity (P < 0.001 in all pairwise comparisons). In multivariate modelling current dehydration, functional dependence, clinical instability and high nutritional risk were associated (P < 0.001) with reduced short- and long-term survival. Conclusions impaired hydration is common in older people acutely admitted to medical care and is associated with poor outcome. Early assessment of calculated serum osmolarity is mandatory to target dehydration and hypoosmolar disorders.

Aims To analyse the prevalence of any‐stage pressure injuries at hospital admission and their impact on short‐, mid‐ and late‐term mortality. Patient characteristics associated with pressure injuries and the impact on hospital costs were also investigated. Background In medical patients acutely admitted to hospital, no study analysed the presence of pre‐existing pressure injuries and the related short‐ and long‐term mortality according to the overall stages of severity thereof. Design Retrospective cohort study following the STROBE guideline. Methods In a population of 7217 acute medical inpatients, the presence and staging of pressure injuries were assessed at hospital admission. The impact of pressure injury on 30‐, 180‐ and 365‐day mortality was analysed by multivariate Cox regression models. Results The prevalence of community‐acquired pressure injuries was 14.9% (stage‐1: 8.1%; stage‐2: 3.5%; stage‐3: 1.6%; stage‐4: 1.1%; unstageable: 0.5%). Hemiplegia/paraplegia, anaemia, poor functional status, high nutritional risk, clinical instability and systemic inflammatory response, but not hydration status, were found to be associated with the occurrence of stage‐2‐and‐above pressure injuries. An increasing difference was found in Diagnosis‐Related Groups (DRG) weight according to pressure injury stages. A distinct and progressively increasing risk‐of‐death for any‐stage pressure injury was shown after 365‐days. A significantly increased mortality risk for all considered time intervals was found for unstageable and stage‐4 pressure injuries. Conclusions In acute medical inpatients, the presence of community‐acquired pressure injuries is part of a multidimensional clinical complexity. The presence and staging of pressure injuries have an independent dramatic impact on of early‐to‐late mortality and hospital costs. Relevance to clinical practice This study documented as community‐acquired pressure injuries are highly prevalent and represents an independent predictor of outcomes in strict dependence of the progression of thereof stage. The presence of community‐acquired pressure injuries should be interpreted as a critical marker of frailty and increased vulnerability.

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