Key result
Meeting all three NECPAL criteria is linked to ~75% higher two-year mortality in heart failure.
Why the study?
Tools to estimate survival in patients with advanced chronic illnesses have limited predictive ability, motivating assessment of the NECPAL tool's performance.
Does the NECPAL CCOMS-ICO tool predict hospital mortality and survival in inpatients with advanced chronic illnesses?
Cohort (n=236)
Yes
Does the NECPAL CCOMS-ICO tool predict hospital mortality and survival in inpatients with advanced chronic illnesses?
Hazard Ratio: 1.75 (95% CI 1.19–2.57)
The NECPAL tool, particularly the presence of all three criteria (NECPAL III), effectively predicts mortality and survival in hospitalized patients with advanced chronic illnesses.
NECPAL in inpatients yields hypothesis-generating survival data; leaves open added predictive value and requires prospective validation.
BACKGROUND: 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. OBJECTIVE: To describe hospital mortality, survival rates, and related variables in a sample of inpatients identified with the NECPAL tool. DESIGN: 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. SETTING/SUBJECTS: 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). RESULTS: 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). CONCLUSIONS: tool can improve the prediction of mortality. The presence of all three NECPAL criteria (NECPAL III) increases the tool's predictive ability.
No takes yet. Share an insight, caveat, or question.
Calsina-Berna et al. (2018) conducted a cohort in Advanced chronic illnesses (n=236). NECPAL III classification vs. Non-NECPAL or NECPAL I-II classification was evaluated on Overall mortality (HR 1.75, 95% CI 1.19-2.57). Patients meeting all three NECPAL criteria (NECPAL III) had a significantly higher risk of mortality, with an 82.5% 2-year mortality rate and an adjusted hazard ratio of 1.75.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: