Hospital management and complications in comorbid patients

INTRODUCCIÓN. La carga de comorbilidades parece estar relacionada con los resultados clínicos en pacientes hospitalizados y la estratificación clínica de los pacientes ingresados podría derivarse utilizando bases de datos administrativas. El objetivo principal de los datos administrativos es obtener retorno de información, no están planificados para la investigación clínica, por lo tanto, cuando se utilizan con fines clínicos, deben evaluarse cuidadosamente porque los temas de interés no pueden definirse con precisión. Por otro lado, las bases de datos administrativas tienen varias ventajas, como la cobertura de la población, el tamaño de muestra muy grande, la heterogeneidad de la población cubierta (perspectiva del "mundo real"), largos períodos de observación, información actualizada, sin costos adicionales para recopilar datos, posibilidad de vincular varias fuentes de información (por ejemplo, hospitalizaciones, atención ambulatoria, recetas de medicamentos, estado vital). Durante la última década, el grupo de investigación de la Unidad Clinica Médica del University Hospital Santa Anna (Ferrara, Italy) ha publicado varios artículos que relacionan bases de datos administrativas con condiciones clínicas. OBJETIVOS General Evaluar la importancia de las comorbilidades recodificadas durante la hospitalización en bases de datos administrativas para comprender el manejo y los factores de riesgo de mortalidad hospitalaria. en la Región Emilia-Romaña de Italia. Específicos - Conocer la relación entre comorbilidad e infecciones en pacientes de Medicina Interna. - Evaluar los factores de riesgo de mortalidad hospitalaria. - Conocer la utilidad de un índice de comorbilidad derivado de una modificación del índice de Elixhauser. - Evaluar el impacto de los ingresos hospitalarios posteriores al trasplante renal en los servicios regionales italianos. - Conocer los costes y el consumo de recursos, expresados por grupos de diagnósticos relacionados (GRD). Diagnósticos relacionados solo con hospitalizaciones de receptores de trasplante renal por todas las causas en la Región Emilia Romagna en Italia. MATERIAL Y MÉTODOS. Estudio retrospectivo en la base de datos administrativa regional de la Región Emilia-Romaña de Italia. La investigación sobre enfermedades infecciosas incluyó ingresos hospitalarios entre enero de 2013 y diciembre de 2016, registrados en la base de datos del hospital local. Se seleccionaron códigos administrativos para identificar infecciones, desarrollo de sepsis y calcular un puntaje de comorbilidad. La segunda parte del trabajo evaluó todos los ingresos hospitalarios de receptores de trasplante renal entre 2001 y 2015. Calculamos el número de ingresos, la edad media, la duración de la estancia en el hospital, el valor medio de GRD y los costos de los ingresos durante el período de los 15 años estudiados. RESULTADOS En la primera parte del presente trabajo evaluamos más de 12.000 registros. Los sujetos fallecidos (n = 1545, 12,7%) eran mayores, tenían un mayor porcentaje de sepsis, infecciones pulmonares y endocarditis. El valor medio de la puntuación de comorbilidad también fue significativamente mayor. La sepsis, la endocarditis, las infecciones pulmonares y las infecciones del tracto urinario se asociaron independientemente con la mortalidad hospitalaria. Del mismo modo, el puntaje de comorbilidad (Odd Ratio – OR 1,070 por unidad de puntaje creciente), también se asoció independientemente con mortalidad intrahopitalaria (MIH). El riesgo ponderado calculado, obtenido al multiplicar 1.070 por el valor de puntaje promedio en pacientes fallecidos, fue de 19,367. Las áreas bajo la curva derivadas del análisis de las características operativas del receptor (ROC) relacionadas con la comorbilidad y el desarrollo de sepsis como predictores de mortalidad hospitalaria fueron 0,724 y 0,670, respectivamente. En la segunda parte del trabajo analizamos 9.197 receptores de trasplante renal ingresados en 15 años. La edad fue de 56,6 ± 1,6 años. Los ingresos fueron de 14,558, y la tasa media de receptores renales admitidos fue de 14.21 (* 100.000). La duración media y mediana de la estancia fue de 8,7 y 6 días, respectivamente. Los costos totales de las admisiones durante el período de estudio fueron de 72.717.232 € con valores medios de DRG de 3.409 €. El número de ingresos y el número total de días necesarios para los receptores de trasplante renal, así como la edad media de los pacientes ingresados, aumentaron de 2001 a 2015, sin embargo, la duración media y mediana de la estancia se mantuvo estable. CONCLUSIONES. La evaluación cuidadosa de la comorbilidad es importante en los pacientes hospitalizados en las Unidades de Medicina Interna por enfermedades infecciosas, ya que la mortalidad hospitalaria está relacionada con la gravedad de la enfermedad y con la multimorbilidad. En estos pacientes, una evaluación cuidadosa de la comorbilidad debe representar un paso fundamental en el manejo de la enfermedad. La base de datos administrativa regional mostró que los costos relacionados con los ingresos de una población específica, como los receptores de trasplante renal, aumentaron gradualmente, probablemente debido al aumento del número de ingresos y al aumento de la edad. Mediante el uso de estas grandes bases de datos es posible evaluar un gran número de pacientes y diferentes entornos hospitalarios. Las bases de datos administrativas contienen información sobre demografía, tipo de hospital donde se realiza la atención, diagnóstico, procedimientos, duración de la estancia y estado al alta. Los investigadores podrían seleccionar condiciones y procedimientos específicos conociendo resultados complejos como la mortalidad. Aunque las bases de datos administrativas subestiman algunas enfermedades, se ha demostrado que son confiables con respecto a la comorbilidad. Es necesario tener en cuenta la comorbilidad para reducir la posible confusión en la investigación epidemiológica y las bases de datos administrativas permiten el desarrollo de nuevos índices de comorbilidad. En la primera parte del trabajo, se informó que la comorbilidad era un factor de riesgo de mortalidad hospitalaria en sujetos ingresados con enfermedades infecciosas. Indirectamente, también probamos un nuevo puntaje de comorbilidad. Finalmente, utilizamos la base de datos administrativa regional para probar una función peculiar de estos archivos. Evaluamos los costos de las hospitalizaciones por trasplante renal. Llegamos a la conclusión de que las bases de datos administrativas podrían utilizarse para la investigación de gestión clínica con diferentes objetivos.INTRODUCTION. Burden of comorbidities appears to be related to clinical outcomes in hospitalized patients and clinical stratification of admitted patients could be derived using administrative databases. The main aim of administrative data is obtained reimbursement, they are not planned for clinical research, therefore when they are used for clinical purposes, they should be carefully evaluated because subjects of interest could not be accurately defined. On the other hand administrative databases have several advantages such as population coverage, very large sample size, heterogeneity of covered population (“real-world” perspective), long observation periods, up to date information, no additional costs for gathering data, possibility to link several sources of information (e.g. hospitalizations, outpatient care, drug prescriptions, vital status). During the last decade, the research group from the Clinica Medina Unit (University Hospital Santa Anna, Ferrara) published several papers relating administrative databases to clinical conditions OBJECTIVES General To evaluate the importance of comorbidities recoded during hospitalization in administrative databases in order to understand management and risk factors for in-hospital mortality in the Region Emilia-Romagna of Italy. Specifics - To know the relationship between comorbidity and infections in internal medicine patients. - To evaluate risk factors for in-hospital mortality - To test the usefulness of a comorbidity score derived from a modification of Elixhauser’s index. - To evaluate impact of hospital admissions subsequent to renal transplantation on Italian regional resources. - To know costs and resource consuming, expressed by diagnosis related groups (DRG) related only to hospitalizations of renal transplant recipients for all causes in the Region Emilia Romagna in Italy. MATERIAL AND METHODS. Retrospective study in the regional administrative database of the Region Emilia-Romagna of Italy. The investigation regarding infectious diseases included hospital admissions between January 2013, and December 2016, recorded in the database of the local hospital. Administrative codes were selected to identify infections, development of sepsis, and to calculate a comorbidity score. The second part of the work evaluated all hospital admissions of renal transplant recipients between 2001 and 2015. We calculated number of admissions, mean age, length of stay in the hospital, mean value of DRG and costs of admissions during the 15 year period of the study. RESULTS In the first half of this work we evaluated more than 12,000 records. Deceased subjects (n=1545, 12.7%) were older, had higher percentage of sepsis, pulmonary infections, and endocarditis. Mean value of comorbidity score was also significantly higher. Sepsis, endocarditis, pulmonary infections, and urinary tracts infections were independently associated with in-hospital mortality. In the same way, comorbidity score (OR 1.070 per unit of increasing score), was independently associated with IHM as well. The calculated weighted risk, obtained by multiplying 1.070 for the mean score value in deceased patients, was 19.367. The areas under the curve derived from receiver operating characteristic (ROC) analysis related to comorbidity and development of sepsis as predictors for in-hospital mortality were 0.724 and 0.670, respectively. In the second part of the work we analysed 9,197 renal transplant recipients admitted in 15 years. Age was 56.6±1.6 years. Admissions were 14,558, and mean rate of admitted renal recipients was 14.21(*100,000). Mean and median length of stay were 8.7 and 6 days, respectively. Total costs of admissions during the study period were € 72,717,232 with mean DRG values of € 3,409. Number of admissions and total number of days required for renal transplant recipients as well as mean age of admitted patients increased from 2001 to 2015, however mean and median length of stay remained stable. CONCLUSIONS. Careful evaluation of comorbidity is important in internal medicine ward patients hospitalized for infectious disease, being in-hospital mortality related to severity of disease, and to multimorbidity. In these patients, a careful evaluation of comorbidity should represent a fundamental step in the disease management. Regional administrative database showed that costs related to admissions of a specific population such as renal transplant recipients gradually increased probably due to the increasing number of admissions and increasing age. By the use of these large databases it is possible to evaluate large number of patients and different hospital settings. Administrative databases contain information on demographic, type of hospital where care take place, diagnosis, procedures, length of stay and discharge status. Researchers could select specific conditions and procedures knowing hard outcomes such as mortality. Although administrative databases underestimate some diseases, it has been shown that they are reliable regarding comorbidity. Comorbidity needs to be taken into account in order to reduce potential confounding in epidemiological research and administrative databases allow the development of new comorbidity indexes. Then in the first part of the work it was reported that comorbidity was a risk factor for inhospital mortality in subjects admitted with infectious diseases. Indirectly, we also tested a new comorbidity score. Finally we used the regional administrative database for testing a function peculiar for these files. We evaluated costs of renal transplant hospitalizations. We conclude that administrative databases could be used for clinical management research aiming at different targets

Pulmonary Hypertension in Dialysis Patients: A Cross-Sectional Italian Study

Introduction. Pulmonary hypertension (PHT) is an independent predictor of mortality. The aim of this study was to relate pulmonary arterial pressure (PAP) to the cardiovascular status of dialysis patients. Methods. 27 peritoneal dialysis (PD) and 29 haemodialysis (HD) patients (60 ± 13 years, 37 males, dialysis vintage was 40 ± 48 months) had PAP measured by echocardiography. Clinical and laboratory data of the patients were recorded. Results. PHT (PAP > 35 mmHg) was detected in 22 patients (39%; PAP 42 ± 6 mmHg) and was diagnosed in 18.5% of PD patients and 58.6% of HD patients (P = .0021). The group of subjects with PH had higher dialysis vintage (63 ± 60 versus 27 ± 32 months, P = .016), interdialytic weight gain (2.1 ± 1 versus 1.3 ± 0.9 Kg, P = .016), lower diastolic blood pressure (73 ± 12 versus 80 ± 8 mmHg, P = .01) and ejection fraction (54 ± 13 versus 60 ± 7%, P = .021) than the patients with normal PAP. PAP was correlated positively with diastolic left ventricular volume (r = 0.32, P = .013) and negatively with ejection fraction (r = −0.54, P < .0001). PHT was independently associated with dialysis vintage (OR 1.022, 95% CI 1.002–1.041, P = .029) and diastolic blood pressure (OR 0.861, 95% CI 0.766–0.967, P = .011). Conclusions. PHT is frequent in dialysis patients, it appears to be a late complication of HD treatment, mainly related to cardiac performance and cardiovascular disease history

Weekend Effect and in-Hospital Mortality in Elderly Patients with Acute Kidney Injury. A Retrospective Analysis of a National Hospital Database in Italy

Background: The aim of this study was to relate the weekend (WE) effect and acute kidney injury (AKI) in elderly patients by using the Italian National Hospital Database (NHD). Methods: Hospitalizations with AKI of subjects aged &gt;= 65 years from 2000-2015 who were identified by the ICD-9-CM were included. Admissions from Friday to Sunday were considered as WE, while all the other days were weekdays (WD). In-hospital mortality (IHM) was our outcome, and the comorbidity burden was calculated by the modified Elixhauser Index (mEI), based on ICD-9-CM codes. Results: 760,664 hospitalizations were analyzed. Mean age was 80.5 +/- 7.8 years and 52.2% were males. Of the studied patients, 9% underwent dialysis treatment, 24.3% were admitted during WE, and IHM was 27.7%. Deceased patients were more frequently comorbid males, with higher age, treated with dialysis more frequently, and had higher admission during WE. WE hospitalizations were more frequent in males, and in older patients with higher mEI. IHM was independently associated with dialysis-dependent AKI (OR 2.711; 95%CI 2.667-2.755,p&lt; 0.001), WE admission (OR 1.113; 95%CI 1.100-1.126,p&lt; 0.001), and mEI (OR 1.056; 95% CI 1.055-1.057,p&lt; 0.001). Discussion: Italian elderly patients admitted during WE with AKI are exposed to a higher risk of IHM, especially if they need dialysis treatment and have high comorbidity burden

Acute Kidney Injury and In-Hospital Mortality. A Retrospective Analysis of a Nationwide Administrative Database of Elderly Subjects in Italy

Background: The aim of this study was to investigate the association between acute kidney injury (AKI) and in-hospital mortality (IHM) in a large nationwide cohort of elderly subjects in Italy. Methods: We analyzed the hospitalization data of all patients aged &gt;= 65 years, who were discharged with a diagnosis of AKI, which was identified by the presence of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), and extracted from the Italian Health Ministry database (January 2000 to December 2015). Data regarding age, gender, dialysis treatment, and comorbidity, including the development of sepsis, were also collected. Results: We evaluated 760,664 hospitalizations, the mean age was 80.5 +/- 7.8 years, males represented 52.2% of the population, and 9% underwent dialysis treatment. IHM was 27.7% (210,661 admissions): Deceased patients were more likely to be older, undergoing dialysis treatment, and to be sicker than the survivors. The population was classified on the basis of tertiles of comorbidity score (the first group 7.48 +/- 1.99, the second 13.67 +/- 2,04, and third 22.12 +/- 4.13). IHM was higher in the third tertile, whilst dialysis-dependent AKI was highest in the first. Dialysis-dependent AKI was associated with an odds ratios (OR) of 2.721; 95% confidence interval (CI) 2.676-2.766; p &lt; 0.001, development of sepsis was associated with an OR of 1.990; 95% CI 1.948-2.033; p &lt; 0.001, the second tertile of comorbidity was associated with an OR of 1.750; 95% CI 1.726-1.774; p &lt; 0.001, and the third tertile of comorbidity was associated with an OR of 2.522; 95% CI 2.486-2.559; p &lt; 0.001. Conclusions: In elderly subjects with AKI discharge codes, IHM is a frequent complication affecting more than a quarter of the investigated population. The increasing burden of comorbidity, dialysis-dependent AKI, and sepsis are the major risk factors

Google Trends on Obesity, Smoking and Alcoholism: Global and Country-Specific Interest

Unhealthy habits or lifestyles, such as obesity, smoking, and alcohol consumption, are involved in the development of non-communicable diseases. The aim of this study was to analyze different communities’ interest in seeking obesity, smoking, and alcohol-related terms through relative search volumes (RSVs) of Google Trends (GT). Internet search query data on obesity, smoking, and alcohol-related terms were obtained from GT from the period between 2010 and 2020. Comparisons and correlations between different topics were calculated considering both global searches and English-, Spanish-, and Italian-speaking areas. Globally, the RSVs for obesity and alcohol-related terms were similar (mean RSVs: 76% and 77%), but they were lower for smoking (65%). High RSVs were found in winter for obesity and smoking-related terms. Worldwide, a negative correlation was found between alcohol and smoking terms (r = −0.72, p < 0.01). In Italy, the correlation was positive (r = 0.58). The correlation between obesity and alcohol was positive in all the cases considered. The interest of global citizens in obesity, smoking, and alcohol was high. The RSVs for obesity were globally higher and correlated with alcohol. Alcohol and smoking terms were related depending on the area considered

Food insecurity and kidney disease. a systematic review

Background: The risk of developing and worsening chronic kidney disease (CKD) is associated with unhealthy dietary patterns. Food insecurity is defined by a limited or uncertain availability of nutritionally adequate and safe food; it is also associated with several chronic medical conditions. The aim of this systematic review is to investigate the current knowledge about the relationship between food insecurity and renal disease. Methods: We selected the pertinent publications by searching on the PubMed, Scopus, and the Web of Science databases, without any temporal limitations being imposed. The searching and selecting processes were carried out through pinpointed inclusion and exclusion criteria and in accordance with the Prisma statement. Results: Out of the 26,548 items that were first identified, only 9 studies were included in the systemic review. Eight out of the nine investigations were conducted in the US, and one was conducted in Iran. The studies evaluated the relationship between food insecurity and (i) kidney disease in children, (ii) kidney stones, (iii) CKD, (iv) cardiorenal syndrome, and (v) end stage renal disease (ESRD). In total, the different research groups enrolled 49,533 subjects, and food insecurity was reported to be a risk factor for hospitalization, kidney stones, CKD, ESRD, and mortality. Conclusions: The relationship between food insecurity and renal disease has been underestimated. Food insecurity is a serious risk factor for health problems in both wealthy and poor populations; however, the true prevalence of the condition is unknown. Healthcare professionals need to take action to prevent the dramatic effect of food insecurity on CKD and on other chronic clinical conditions

Sleep quality and medication adherence in older adults. A systematic review

Sleep quality significantly impacts individuals' overall health, especially in older adults. Older adults often face comorbid conditions, polypharmacy (the intake of five or more medications per day), and medication non-adherence, which are common among those with sleep disorders. The purpose of this systematic review is to examine the relationship between sleep quality and medication adherence in older adults and to describe the measuring instruments used. A systematic review was performed following the PRISMA guidelines. The PubMed, Scopus, Cochrane Library, and CINAHL databases were screened from January 2024 to March 2024. Nine articles were included in the final synthesis based on the inclusion and exclusion criteria. The review found that poor sleep quality is significantly associated with reduced medication adherence in older adults. The key sleep determinants linked to medication non-adherence include sleep disorders, sleep efficiency, sleep duration, and daytime dysfunctions. Inappropriate medication prescriptions have been associated with reduced sleep efficiency. The tools for assessing sleep quality and medication adherence are predominantly subjective and varied. To address these challenges, a comprehensive geriatric assessment should include investigations into sleep disorders and comorbidity factors. Additionally, nursing educational interventions could be pivotal in improving medication adherence among older adults

Individual Circadian Preference, Eating Disorders and Obesity in Children and Adolescents: A Dangerous Liaison? A Systematic Review and a Meta-Analysis

Obesity and other eating disorders are an actual public health problem, especially in childhood and adolescents, and could be also related with chronotype. The aim of this systematic review was to determine the relationship between eating disorders, obesity and the different chronotypes in children and adolescents. Methods: A systematic review of observational studies evaluating young populations dealing with and evaluating chronotype was conducted. Electronic searches were performed in six international databases. A qualitative thematic-categorical analysis was carried out and a random-effects model was used for the quantitative analysis (meta-analysis). Results: Fifteen studies were included, but quantitative analysis was only carried out in three of them. Children and adolescents with an evening chronotype had higher body mass index, consumed more junk food or were more predisposed to suffer from food addiction and night eating syndrome. Conclusions: Children and adolescents with evening chronotype had higher tendency to incorrect eating behaviors and were suffering from overweight/obesity. Environment but also lifestyle factors should be considered in the association between chronotype and eating disorders and obesity