title: Predictors of clinical events occurring during hospital stay among elderly patients admitted to medical wards in Italy.
abstract: BACKGROUND
  Clinical events occurring during hospital stay are independent predictors of prolonged hospitalization, in-hospital mortality and readmission among elderly patients admitted to medical wards.
  
  
  OBJECTIVE
  To identify predictors of intercurrent clinical events (ICE) during hospital stay among the main demographic, functional and clinical characteristics assessed at hospital admission in a multicenter sample of elderly inpatients in Italy.
  
  
  METHODS
  This observational prospective cohort study was conducted in 66 internal and geriatric medicine hospital wards in 2010. It enrolled 1267 inpatients aged 65years or older living at home before hospitalization. Multivariable Poisson regression analyses were employed to identify the most common ICEs as well as their independent predictors.
  
  
  RESULTS
  During the hospital stay 427 patients (33.7%) experienced at least one ICE. The most common ICEs were urinary tract infections, pneumonia, anemia, arrhythmias and fluid electrolyte disorders. After correction for age, sex, comorbidity, cognitive impairment and functional dependence, independent predictors of any ICE were: being a bladder catheter holder (RR [risk ratio] 1.86, 95% CI 1.52-2.27), being on treatment at home with a proton pump inhibitor (PPI) (RR 1.25, 95% CI 1.03-1.53), with immunosuppressant therapy (RR 2.10, 95% CI 1.24-3.56), and body temperature at admission (RR 1.19, 95% CI 1.06-1.33).
  
  
  CONCLUSIONS
  Four clinical characteristics, easily assessable at admission, may be useful to identify elderly inpatients at a higher risk for developing ICEs during hospital stay. Furthermore three of these predictors are modifiable factors, thus interventions reducing the use of catheter, PPI and immunosuppressants may result in reduction of ICEs.
authors.affiliation: Geriatric Unit, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milan, Italy. Electronic address: paolo.rossi@policlinico.mi.it.
authors.forename: Paolo Dionigi
authors.initials: PD
authors.lastname: Rossi
authors.affiliation: Geriatric Medicine Outpatient Service, Presidio Territoriale Poliambulatori, ASST Nord Milano, viale Andrea Doria 52, 20124 Milan, Italy. Electronic address: claudio.bilotta@gmail.com.
authors.forename: Claudio
authors.initials: C
authors.lastname: Bilotta
authors.affiliation: Department of Preventive Medicine, Unit of Epidemiology, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milan, Italy. Electronic address: dario.consonni@unimi.it.
authors.forename: Dario
authors.initials: D
authors.lastname: Consonni
authors.affiliation: Laboratory for Quality Assessment of Geriatric Therapies and Services, Mario Negri Institute for Pharmacological Research, Milan, Italy. Electronic address: alessandro.nobili@marionegri.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Nobili
authors.affiliation: School of Specialization in Geriatrics and Gerontology, University of Milan, Milan, Italy. Electronic address: sarah.damanti@hotmail.it.
authors.forename: Sarah
authors.initials: S
authors.lastname: Damanti
authors.affiliation: Geriatric Unit, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milan, Italy; Department of Clinical Sciences & Community Health, University of Milan, Milan, Italy. Electronic address: maura.marcucci@unimi.it.
authors.forename: Maura
authors.initials: M
authors.lastname: Marcucci
authors.affiliation: A. Bianchi Bonomi Hemophilia and Thrombosis Center, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milan, Italy. Electronic address: piermannuccio.mannucci@policlinico.mi.it.
authors.forename: Pier Mannuccio
authors.initials: PM
authors.lastname: Mannucci
authors.affiliation: Geriatric Unit, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milan, Italy; Department of Clinical Sciences & Community Health, University of Milan, Milan, Italy. Electronic address: daniela.mari@unimi.it.
authors.forename: Daniela
authors.initials: D
authors.lastname: Mari
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000453:epidemiology*; D001145:Arrhythmias, Cardiac / Q000453:epidemiology*; D001831:Body Temperature; D005260:Female; D005334:Fever / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007558:Italy / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011014:Pneumonia / Q000453:epidemiology*; D016012:Poisson Distribution; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D018570:Risk Assessment; D012307:Risk Factors; D014546:Urinary Catheterization / Q000706:statistics & numerical data; D014552:Urinary Tract Infections / Q000453:epidemiology*; D014883:Water-Electrolyte Imbalance / Q000453:epidemiology*
chemical_list: D007166:Immunosuppressive Agents; D054328:Proton Pump Inhibitors
keywords: Adverse events; Elderly; Hospitalization; Intercurrent clinical events; REPOSI