Intrahospital Mortality and Survival of Patients with Advanced Chronic Illnesses in a Tertiary Hospital Identified with the NECPAL CCOMS-ICO © Tool

• Published in: Journal of palliative medicine Vol. 21; no. 5; p. 665
• Main Authors: Calsina-Berna, Agnès, Martinez-Muñoz, Marisa, Bardés Robles, Ignasi, Beas Alba, Elba, Madariaga Sánchez, Rafael, Gómez Batiste Alentorn, Xavier
• Format: Journal Article
• Language: English
• Published: United States 01.05.2018
• Subjects: Adult; Aged; Chronic Disease - mortality; Cohort Studies; Cross-Sectional Studies; Female; Hospital Mortality; Humans; Longitudinal Studies; Male; Middle Aged; Palliative Care - standards; Palliative Care - statistics & numerical data; Prognosis; Risk Assessment - methods; Surveys and Questionnaires; Survival Analysis; Tertiary Care Centers - statistics & numerical data; hospitals; palliative care; prognosis; chronic disease
• ISSN: 1557-7740
• DOI: 10.1089/jpm.2017.0339

Between 69% and 82% of patients with advanced chronic illness require palliative care (PC). The NECPAL CCOMS-ICO tool can identify these individuals. Tools to estimate survival are available, but have limited predictive ability, and therefore we sought to assess if NECPAL could improve survival prediction. To describe hospital mortality, survival rates, and related variables in a sample of inpatients identified with the NECPAL tool. Cross-sectional study with longitudinal cohort follow-up. Sociodemographic and clinical data were analyzed. A predictive model (Cox regression analysis) was performed to assess survival. Patients admitted to a tertiary hospital. Included patients were considered to be especially affected by their chronic condition and NECPAL+ patients (surprise question [SQ]+ plus ≥1 of the tool's other three criteria). Patients were classified into three subgroups: non-NECPAL (either SQ- or not meeting any additional NECPAL criteria); NECPAL I-II (SQ+ with one to two additional criteria); and NECPAL III (SQ+ with all three additional criteria). Of the 602 inpatients, 236 (39.2%) were included. Of these, 49 (20.3%) died during hospitalization: 14 (13.3%) were NECPAL I-II; 34 (35.1%) were NECPAL III; and none were non-NECPAL (p < 0.001). At two years, 146 deaths (61.9%) were observed: 9 (26.5%) non-NECPAL; 57 (54.3%) NECPAL I-II; and 80 (82.5%) NECPAL III (p < 0.001). Median survival was 9.1 months. Variables associated with higher mortality were NECPAL III classification (hazard ratio [HR]: 1.75 [1.19-2.57]); in need of PC (HR: 2 [1.27-3.13]); dysphagia (HR: 1.7 [1.12-2.58] 6); cancer (HR: 3.21 [2.19-4.71]); and age >85 years (HR: 2.52 [1.46-4.35]). At six months, the NECPAL had an area under the curve (AUC) of 0.7 (95% confidence interval [CI]: 0.632-0.765), and at 24 months, the NECPAL AUC was 0.717 (95% CI: 0.650-0.785). The NECPAL CCOMS-ICO tool can improve the prediction of mortality. The presence of all three NECPAL criteria (NECPAL III) increases the tool's predictive ability.