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

Abstract

Background: 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.

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: 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.