Baseline conditions and nutritional state upon hospitalization are the greatest risks for mortality for cardiovascular diseases and for several classes of diseases: a retrospective study

Abstract

The aim of this retrospective study was to evaluate risk factors for 3-years mortality after hospital discharge in all inpatients admitted to a general hospital in Milano, Italy. A total of 2580 consecutive patients admitted to Ospedale San Paolo, July 1 to December 31, 2012, for several classes of diseases (internal medicine, cancer, infectious diseases, trauma and surgery, pneumonia, and heart diseases) were studied. Age, total disease, type of admission, length of admission, age-adjusted Charlson index, prognostic nutritional index (PNI), and full blood count were evaluated. Univariate Cox models were used to evaluate the association between variables and death. Of the 2580 consecutive patients (age 66.8 ± 19.36 years, mean ± SD), 920 died within 3 years after discharge. At univariate analysis, all investigated variables, except sex and lymphocytes, were associated with patient death. Stepwise regression analyses revealed that the age-adjusted Charlson index or age plus total diseases, type of admission, number of admissions, and PNI were significant risk factors in the whole sample and in some classes of disease. Results were superimposable when considering death from date of admission instead of date of discharge, meaning that in-hospital death was not relevant to the total death count (115 out of 902). Seriousness of baseline conditions represents the major risk factor for mortality in most classes of disease, and possibly influences other predictors, such as type of admission and length of stay. This suggests that the current model of hospital admission might be improved, for instance, through comprehensive care at home, instead of hospital admission, or before admission.

Comparative analysis of multiple nutritional scoring tools to predict the incidence of adverse events in elderly patients with acute coronary syndrome after PCI

“…The main results were as follows: among the four assessment tools, the AUC, PPV, and NPV of PNI and GNRI were signi cantly higher than those of CONUT and BMI; this nding is consistent with the results of other studies [18,29] . The PNI predicted the greatest incremental value of risk, with patients with low nutritional scores having a higher risk of MACE than those with high nutritional scores [30] . According to the calibration curves, the three prediction models constructed from PNI, GNRI, and CONUT had good calibration ability; the decision analysis curves (DCA) suggested that the models constructed from PNI and GNRI had high clinical validity, while the prediction model constructed from BMI had poor clinical validity.…”

Alanine transferase levels (ALT) and triglyceride-glucose index are risk factors for type 2 diabetes mellitus in obese patients

“…Therefore, together with hospital admissions, exemptions were considered a proxy of development of chronic diseases. This procedure has previously been employed and validated [ 8 , 11 , 12 ].…”