Prognostic value for mortality of the new FADOI-COMPLIMED score(s) in patients hospitalized in medical wards.

BACKGROUND: Recently we defined a user-friendly tool (FADOI-COMPLIMED scores-FCS) to assess complexity of patients hospitalized in medical wards. FCS-1 is an average between the Barthel Index and the Exton-Smith score, while FCS-2 is obtained by using the Charlson score. The aim of this paper is to assess the ability of the FCS to predict mortality in-hospital and after 1-3-6-12-months. In this perspective, we performed comparisons with the validated Multidimensional Prognostic Index (MPI). METHODS: It is a multicenter, prospective observational study, enrolling patients aged over 40, suffering from at least two chronic diseases and consecutively admitted to Internal Medicine departments. For each patient, data from 13 questionnaires were collected. Survival follow-up was conducted at 1-3-6-12 months after discharge. The relationships between cumulative incidences of death with FCS were investigated with logistic regression analyses. ROC curve analyses were performed in order to compare the predictiveness of the logistic models based on FCS with respect to those with MPI taken as reference. RESULTS: A cohort of 541 patients was evaluated. A 10-point higher value for FCS-1 and FCS-2 leads to an increased risk of 1-year death equal to 25.0% and 27.1%, respectively. In case of in-hospital mortality, the relevant percentages were 63.1% and 15.3%. The logistic model based on FCS is significantly more predictive than the model based on MPI (which requires an almost doubled number of items) for all the time-points considered. CONCLUSIONS: Assessment of prognosis of patients has the potential to guide clinical decision-making and lead to better care. We propose a new, efficient and easy-to-use instrument based on FCS, which demonstrated a good predictive power for mortality in patients hospitalized in medical wards. This tool may be of interest for clinical practice, since it well balances feasibility (requiring the compilation of 34 items, taking around 10 minutes) and performance.

Nocturnal Blood Pressure Dipping is Abolished in Old-Elderly Hospitalized Patients.

INTRODUCTION: During sleep there is reduction of blood pressure (BP) caused by a decrease of the sympathetic nervous tone. This nocturnal "dipping" phenomenon, assessable with ambulatory blood pressure monitoring (ABPM), is blunted with increasing age. AIM: To assess the effect of hospitalization on night-time BP fall in old-elderly patients. METHODS: We analysed 78 ABPM of old-elderly hospitalized patients (mean age 91 ± 0.5 years) and those of 18 outpatients as control group. The nocturnal BP fall was assessed calculating: the dipping value (DV) i.e. the difference between mean diurnal systolic BP (mDSBP) and mean nocturnal systolic BP (mNSBP) and the "dipping pattern" i.e. mNSBP/mDSBPx100. RESULTS: Hospitalized patients showed a lower rate of normal dipping patterns (9 vs. 39%), an higher rate of reverse dippers (59 vs. 28%; p < 0.05) and a lower DV (-0.9 ± 1 vs. 9 ± 4 mmHg; p < 0.05) than patients of control group. At multivariate regression analysis including age, gender and hospitalization, DV was significantly correlated only with the hospitalization (ß -0.3, t -2.9; p < 0.05). CONCLUSIONS: In old-elderly hospitalized patients nocturnal BP fall is abolished. This enhancement of the age related reduction of nocturnal BP dipping may be due to the stress associated with hospital environment.

ABPM Induced Alarm Reaction: A Possible Cause of Overestimation of Daytime Blood Pressure Values Reduced By Treatment with Beta-Blockers.

INTRODUCTION: Alarm reaction to clinical blood pressure (BP) measurement, defined white-coat effect (WCE), can cause overestimation of true BP values. AIM: To assess whether ambulatory blood pressure monitoring (ABPM) can similarly affect BP values during the initial hours of recording. METHODS: In 420 ABPMs selected for a first systolic BP (SBP) reading at least 10 mmHg higher than the mean daytime SBP, we calculated mean diurnal and 24 h SBP with and without the exclusion of the two first hours of recording defined as the WCE window (WCEw). We also calculated the magnitude and duration of WCE. These analyses were also performed separately in patients off anti-hypertensive treatment (n = 156), and on treatment with and without the inclusion of beta-blockers (respectively n = 113 and 151). RESULTS: Exclusion of WCEw period reduced mean diurnal and 24 h SBP respectively from 135 ± 0.5 to 133 ± 0.5 (p < 0.01) and from 131 ± 0.5 to 130 ± 0.5 (p < 0.02). As a result the percentage of patients diagnosed as having diurnal or 24 h hypertension was reduced respectively from 48 to 40 % and from 52 to 47 %. The magnitude of WCEw was similar in both genders but the duration was longer in females (66 ± 2 vs. 56 ± 2 min, p < 0.01). Treatment with beta-blockers was associated with a shorter duration of WCE in both genders but this effect was statistically significant only in males. CONCLUSIONS: In some patients ABPM is not free from WCE. WCE may affect the overall estimation of BP profile and is longer but less blunted by beta-blockers in females than in males.

High prevalence of fragility vertebral fractures in patients hospitalised in Internal Medicine Units. Results of the POINT (Prevalence of Osteoporosis in INTernal medicine) study.

BACKGROUND: Osteoporotic vertebral fractures (VFs) often go unrecognised in both healthy individuals and in pathological conditions. Few data exist on VFs in patients hospitalised in Internal Medicine Units (IMUs), who often suffer from multiple concomitant chronic disorders. AIM OF THE STUDY: This multicentre cross-sectional study was aimed at assessing the prevalence of VFs in an unselected population of patients referring to IMUs. Correlations between VFs and the main coexisting diseases were also investigated. METHODS: Information on demographic, clinical and laboratory findings, and on the presence of known risk factors for osteoporosis was recorded. The Genant's semi-quantitative method was used to evaluate, in a central reading centre, the presence and severity of VFs in the thoracic and lumbar spine. RESULTS: A cohort of 995 patients was evaluated. At least one VF of any grade was found in 47.5% of patients, with similar prevalence between females (48.1%) and males (46.7%). Older age, chronic obstructive pulmonary disease, and previous diagnosis of osteoporosis showed a significant association with VFs in multivariable analysis. However, 79.7% of the VFs were observed in patients without previous diagnosis of osteoporosis. Moreover, a VF of grade 2 or greater was found in 20.8% of patients. CONCLUSIONS: Fragility VFs is a very frequent finding in patients hospitalised in IMUs. Consequently, more attention should be devoted in this clinical setting to this comorbidity, which is known to be an additional factor for mortality and, when localised in the thoracic part of the spine, may negatively influence a concomitant respiratory insufficiency.