6533b7d0fe1ef96bd125ba3b
RESEARCH PRODUCT
In-hospital death and adverse clinical events in elderly patients according to disease clustering: The REPOSI study
A MarengoniF BonomettiA NobiliM TettamantiF SalernoS CorraoA IorioM MarcucciPm MannucciItalian Society Of Internal Medicine (Simi) Investigators. Tedeschi AR RossioG MoreoB FerrariA MammarellaV RaparelliS RondinellaI GiannicoL RascitiS GualandiV MonzaniV SavojardoG FabioS ColomboA QuercioliA BarrecaE Durante-mangoniD PintoE IncasaE RizzoliM VanoliG CasellaG MuscaO CuccurulloG FamularoMr SajevaA PicardiD HilaR RozziniA GiordanoA BonelliG DentamaroG GobboM CazzanigaP GaudenziL GiustoD RizzoniL CastoldiD MariG MicaleE AltomareG ServiddioC LonghiniC MolinoS DeiddaLm CuccuruM QuaglioloGr CentenaroAl PasquiL PuccettiG BertolinoP CavalloD BertoliniNl LiberatoA PerciccanteA CoralliL AnastasioL BertucciG AgnelliA MacuraC MorabitoR FavaA TuttolomondoR Di SciaccaL MacchiniA RealdiA FiorentiniC TofiC CagnoniA ManucraG RomanelliM CortellaroMr MeroniDp RossiC. Verganisubject
MaleAgingDisease clustersPediatricsmedicine.medical_specialtySettore MED/09 - Medicina InternaHospital unitDiseaseHospital mortalitydisease clusteringLogistic regressionNO80 and overMedicineCluster AnalysisHumansHospital MortalityAgedAged 80 and overIn hospital deathMedical Errorsbusiness.industryClinical eventsAged; Aged 80 and over; Cluster Analysis; Female; Hospital Mortality; Humans; Italy; Male; Medical ErrorsREPOSIIn-hospital death; elderly patients; disease clustering; REPOSIIn-hospital deathOdds ratioSettore MED/45 - Scienze Infermieristiche Generali Cliniche E Pediatricheelderly patientItalyFemaleGeriatrics and Gerontologybusinesspatients at risk of in-hospital death; adverse clinical events according to disease clusteringdescription
OBJECTIVE: The aim of the study was to recognize clusters of diseases among hospitalized elderly and to identify groups of patients at risk of in-hospital death and adverse clinical events according to disease clustering. METHOD: This was a cross-sectional study conducted in 38 internal medicine and geriatric wards in Italy participating in the Registro Politerapie SIMI (REPOSI) study during 2008. The subjects were 1,332 inpatients aged 65 years or older. Clusters of diseases (i.e., two or more co-occurrent diseases) were identified using the odds ratios (OR) for the associations between pairs of conditions, followed by cluster analysis. Logistic regression models were used to evaluate the effect of disease clusters on in-hospital death and adverse clinical events. RESULTS: A total of 86.7% of the patients were discharged, 8.3% were transferred to another hospital unit, and 5.0% died during hospitalization; 36.4% of the patients had at least one adverse clinical event. Patients affected by the clusters, including heart failure (HF) and either chronic renal failure (CRF) or chronic obstructive pulmonary disease, had a significant association with in-hospital death (OR, 4.3;95% confidence interval [CI], 1.6-11.5; OR, 2.9; 95% CI, 1.1-8.3, respectively), as well as patients affected by CRF and anemia (OR, 6.1; 95% CI, 2.3-16.2). The cluster including HF and CRF was also associated with adverse clinical events (OR, 3.5; 95% CI, 1.5-7.8). The effect of both HF and CRF and anemia and CRF on in-hospital death was additive. CONCLUSION: Several groups of older patients at risk of in-hospital death and adverse clinical events were identified according to disease clustering. Knowledge of the relationship among co-occurring diseases may help developing strategies to improve clinical practice and preventative interventions.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2010-08-01 |