Three-month mortality in permanently bedridden medical non-oncologic patients. The BECLAP study (permanently BEdridden, creatinine CLearance, albumin, previous hospital admissions study)

Abstract

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 3months 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.

Feeding who, when and how, dysphagia in advanced dementia

“…Dysphagia and mental impairment can lead to malnutrition and low albumin level, which is associated to a poorer prognosis. 1,2,3 Therefore, management of dysphagia in elderly suffering from cognitive impairment is a quite delicate issue. 1 Enteral tube feeding is a common intervention during hospitalizations, used to manage dysphagia and poor food intake, especially in advanced dementia.…”

A decision-making algorithm proposal for PICCs and midlines insertion in patients with advanced kidney disease: A pilot study

“…Charlson Comorbidity Index [13], Beclap score [14] and renal function were calculated for each patient at the time of the catheter insertion in order to estimate patients' prognosis and to evaluate the eventual presence of CKD at enrollment time.…”

“…Charlson Comorbidity Index, 13 Beclap score, 14 and renal function were calculated for each patient at the time of the catheter insertion in order to estimate patients' prognosis and to evaluate the presence of CKD at enrollment time. We then followed patients for 2 years through the SISS regional network system (Sistema Informativo Socio Sanitario) in order to assess patients' 2-year mortality.…”

“…Thus, the aim of this study is to carry out a global assessment of mortality at 2 years through Charlson Comorbidity Index (CCI) [13] and Beclap score [14], in order to identify patients with poor survival prognosis, assuming they would not need chronic hemodialysis. We than verified that the follow up of these patients confirmed death within two years and no dialysis.…”

“…Many other mortality risk score are reported in the literature, the most commonly used is the Charlson Comorbidity Index (CCI) 13 that calculates the estimated mortality risk at 10 and 2 years; a newer and promising score is the Beclap score 14 assessing mortality of nononcological patients at 3 and 6 months.…”