Polypharmacy-Comorbidity Score is an Independent Predictor of Hospital Mortality and Readmissions for Medical-Surgical Patients Across All Age Groups

Tolentino, Julia C.; Harris, Riley; Mazza, Amanda; Foltz, Daniel F.; Stoltzfus, Jill; Deringer, Peter; Sabol, Donna M.; Sakran, Joseph V.; Papadimos, Thomas J; Stawicki, Stanislaw P.

doi:10.1016/j.jamcollsurg.2016.06.123

Cited by 2 publications

(3 citation statements)

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“…[ 76 77 117 ] It is broadly understood that patient frailty, representing a conglomerate of “physiological age” and “chronological age,” is among the key outcome determinants. [ 238 239 240 241 242 243 ] Although COVID-19 tends to be less severe in younger populations, no age group is truly spared, and mortality among the younger patients may be related with symptomatic severity of the infection and comorbid conditions (e.g., morbid obesity, asthma, insulin-dependent diabetes, and malignancy). [ 244 ] In face of a rapidly evolving pandemic, the simpler and easier it is to implement a risk stratification protocol for comorbidity-related risk, the better the ability to quickly and accurately triage patients.…”

Section: P Atient F Railty P mentioning

confidence: 99%

The 2019–2020 novel coronavirus (severe acute respiratory syndrome coronavirus 2) pandemic: A joint american college of academic international medicine-world academic council of emergency medicine multidisciplinary COVID-19 working group consensus paper

Stawicki

Jeanmonod

Miller

et al. 2020

J Global Infect Dis

332

356

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What started as a cluster of patients with a mysterious respiratory illness in Wuhan, China, in December 2019, was later determined to be coronavirus disease 2019 (COVID-19). The pathogen severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel Betacoronavirus , was subsequently isolated as the causative agent. SARS-CoV-2 is transmitted by respiratory droplets and fomites and presents clinically with fever, fatigue, myalgias, conjunctivitis, anosmia, dysgeusia, sore throat, nasal congestion, cough, dyspnea, nausea, vomiting, and/or diarrhea. In most critical cases, symptoms can escalate into acute respiratory distress syndrome accompanied by a runaway inflammatory cytokine response and multiorgan failure. As of this article's publication date, COVID-19 has spread to approximately 200 countries and territories, with over 4.3 million infections and more than 290,000 deaths as it has escalated into a global pandemic. Public health concerns mount as the situation evolves with an increasing number of infection hotspots around the globe. New information about the virus is emerging just as rapidly. This has led to the prompt development of clinical patient risk stratification tools to aid in determining the need for testing, isolation, monitoring, ventilator support, and disposition. COVID-19 spread is rapid, including imported cases in travelers, cases among close contacts of known infected individuals, and community-acquired cases without a readily identifiable source of infection. Critical shortages of personal protective equipment and ventilators are compounding the stress on overburdened healthcare systems. The continued challenges of social distancing, containment, isolation, and surge capacity in already stressed hospitals, clinics, and emergency departments have led to a swell in technologically-assisted care delivery strategies, such as telemedicine and web-based triage. As the race to develop an effective vaccine intensifies, several clinical trials of antivirals and immune modulators are underway, though no reliable COVID-19-specific therapeutics (inclusive of some potentially effective single and multi-drug regimens) have been identified as of yet. With many nations and regions declaring a state of emergency, unprecedented quarantine, social distancing, and border closing efforts are underway. Implementation of social and physical isolation measures has caused sudden and profound economic hardship, with marked decreases in global trade and local small business activity alike, and full ramifications likely yet to be felt. Current state-of-science, mitigation strategies, possible therapies, ethical considerations for healthcare workers and policymakers, as well as lessons learned for this evolving global threat and the eventual return to a “new normal” are discussed in this article.

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Section: P Atient F Railty P mentioning

confidence: 99%

The 2019–2020 novel coronavirus (severe acute respiratory syndrome coronavirus 2) pandemic: A joint american college of academic international medicine-world academic council of emergency medicine multidisciplinary COVID-19 working group consensus paper

Stawicki

Jeanmonod

Miller

et al. 2020

J Global Infect Dis

332

356

View full text Add to dashboard Cite

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“…The random effect was also assumed to follow a normal distribution and the standard deviation of the random effects is given a normal prior distribution between 0 and 1. We defined the prior on the scales of the coefficients as shown in Eqs [14][15][16][17][18][19][20].…”

Section: Plos Digital Healthmentioning

confidence: 99%

“…Large-scale clinical trials of polypharmacy are difficult to carry out and it has not previously been characterized in a population-wide setting with respect to dosage-adjustments, which is of obvious importance to expected DDIs and ADRs. Instead, polypharmacy has typically been addressed in the elderly or in selected phenotypes with reference to surrogate measures like the medication burden index [11][12][13] and the comorbidity-polypharmacy score [14,15], which are useful, but do ignore many aspects of drug treatment contexts [11]. Another common approach is to assess polypharmacy by means of standard evaluation of potential pharmacokinetic inhibitors and inductors in relation to a known DDI.…”

Section: Introductionmentioning

confidence: 99%

Drug dosage modifications in 24 million in-patient prescriptions covering eight years: A Danish population-wide study of polypharmacy

Leal Rodríguez,

Haue,

Mazzoni

et al. 2023

PLOS Digit Health

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Polypharmacy has generally been assessed by raw counts of different drugs administered concomitantly to the same patients; not with respect to the likelihood of dosage-adjustments. To address this aspect of polypharmacy, the objective of the present study was to identify co-medications associated with more frequent dosage adjustments. The data foundation was electronic health records from 3.2 million inpatient admissions at Danish hospitals (2008–2016). The likelihood of dosage-adjustments when two drugs were administered concomitantly were computed using Bayesian logistic regressions. We identified 3,993 co-medication pairs that associate significantly with dosage changes when administered together. Of these pairs, 2,412 (60%) did associate with readmission, mortality or longer stays, while 308 (8%) associated with reduced kidney function. In comparison to co-medications pairs that were previously classified as drug-drug interactions, pairs not classified as drug-drug interactions had higher odds ratios of dosage modifications than drug pairs with an established interaction. Drug pairs not corresponding to known drug-drug interactions while still being associated significantly with dosage changes were prescribed to fewer patients and mentioned more rarely together in the literature. We hypothesize that some of these pairs could be associated with yet to be discovered interactions as they may be harder to identify in smaller-scale studies.

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Polypharmacy-Comorbidity Score is an Independent Predictor of Hospital Mortality and Readmissions for Medical-Surgical Patients Across All Age Groups

Cited by 2 publications

References 0 publications

The 2019–2020 novel coronavirus (severe acute respiratory syndrome coronavirus 2) pandemic: A joint american college of academic international medicine-world academic council of emergency medicine multidisciplinary COVID-19 working group consensus paper

The 2019–2020 novel coronavirus (severe acute respiratory syndrome coronavirus 2) pandemic: A joint american college of academic international medicine-world academic council of emergency medicine multidisciplinary COVID-19 working group consensus paper

Drug dosage modifications in 24 million in-patient prescriptions covering eight years: A Danish population-wide study of polypharmacy

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