Hyperglycemia at admission, comorbidities, and in-hospital mortality in elderly patients hospitalized in internal medicine wards: data from the RePoSI Registry
Salvatore Corrao, Alessandro Nobili, Giuseppe Natoli, Pier Mannuccio Mannucci, Francesco Perticone, Antonello Pietrangelo, Christiano Argano, on behalf of the REPOSI Investigators, Pier Mannuccio Mannucci, Alessandro Nobili, Antonello Pietrangelo, Francesco Perticone, Giuseppe Licata, Francesco Violi, Gino Roberto Corazza, Salvatore Corrao, Alessandra Marengoni, Francesco Salerno, Matteo Cesari, Mauro Tettamanti, Luca Pasina, Carlotta Franchi, Carlotta Franchi, Laura Cortesi, Mauro Tettamanti, Gabriella Miglio, Mauro Tettamanti, Laura Cortesi, Ilaria Ardoino, Alessio Novella, Domenico Prisco, Elena Silvestri, Giacomo Emmi, Alessandra Bettiol, Cenci Caterina, Gianni Biolo, Michela Zanetti, Martina Guadagni, Michele Zaccari, Massimiliano Chiuch, Michele Zaccari, M. Vanoli, Giulia Grignani, E.A. Pulixi, Mauro Bernardi, Silvia Li Bassi, Luca Santi, Giacomo Zaccherini, Graziana Lupattelli, Elmo Mannarino, Vanessa Bianconi, Francesco Paciullo, Riccardo Alcidi, Ranuccio Nuti, Roberto Valenti, Martina Ruvio, Silvia Cappelli, Alberto Palazzuoli, Domenico Girelli, Fabiana Busti, Giacomo Marchi, Mario Barbagallo, Ligia J. Domínguez, Floriana Cocita, Vincenza Beneduce, Lidia Plances, Giuseppe Natoli, Salvatore Mularo, Massimo Raspanti, Christiano Argano, Marco Zoli, Ilaria Lazzari, Mattia Brunori, Elisa Fabbri, Donatella Magalotti, Raffaella Arnò, Franco Laghi‐Pasini, Pier Leopoldo Capecchi, Giuseppe Palasciano, Maria Ester Modeo, Carla Di Gennaro, Maria Domenica Cappellini, Diletta Maira, Valeria Di Stefano, Giovanna Fabio, Sonia Seghezzi, Marta Mancarella, Margherita Migone De Amicis, Giacomo De Luca, Natalia Scaramellini, Matteo Cesari, Paolo Rossi, Sarah Damanti, Marta Clerici, Federica Conti, Giulia Bonini, Barbara Ottolini, Antonio Di Sabatino, Emanuela Miceli, Marco Vincenzo Lenti
Abstract
AIMS: The association between hyperglycemia at hospital admission and relevant short- and long-term outcomes in elderly population is known. We assessed the effects on mortality of hyperglycemia, disability, and multimorbidity at admission in internal medicine ward in patients aged ≥ 65 years. METHODS: Data were collected from an active register of 102 internal medicine and geriatric wards in Italy (RePoSi project). Patients were recruited during four index weeks of a year. Socio-demographic data, reason for hospitalization, diagnoses, treatment, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), renal function, functional (Barthel Index), and cognitive status (Short Blessed Test) and mood disorders (Geriatric Depression Scale) were recorded. Mortality rates were assessed in hospital 3 and 12 months after discharge. RESULTS: Of the 4714 elderly patients hospitalized, 361 had a glycemia level ≥ 250 mg/dL at admission. Compared to subjects with lower glycemia level, patients with glycemia ≥ 250 mg/dL showed higher rates of male sex, smoke and class III obesity. These patients had a significantly lower Barthel Index (p = 0.0249), higher CIRS-SI and CIRS-CI scores (p = 0.0025 and p = 0.0013, respectively), and took more drugs. In-hospital mortality rate was 9.2% and 5.1% in subjects with glycemia ≥ 250 and < 250 mg/dL, respectively (p = 0.0010). Regression analysis showed a strong association between in-hospital death and glycemia ≥ 250 mg/dL (OR 2.07; [95% CI 1.34-3.19]), Barthel Index ≤ 40 (3.28[2.44-4.42]), CIRS-SI (1.87[1.27-2.77]), and male sex (1.54[1.16-2.03]). CONCLUSIONS: The stronger predictors of in-hospital mortality for older patients admitted in general wards were glycemia level ≥ 250 mg/dL, Barthel Index ≤ 40, CIRS-SI, and male sex.