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Original Article
DOI: 10.1016/j.arbr.2021.03.007
Available online 14 March 2021
Prevalence and mortality of patients with palliative needs in an acute respiratory setting
Prevalencia y mortalidad de pacientes con necesidades paliativas en una planta de Neumología. Estudio prospectivo
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Eva Tabernero Hugueta,
Corresponding author
evataberna@yahoo.es

Corresponding author.
, Borja Ortiz de Urbina Antiaa, Beatriz González Queroa, Elena Garay Llorentea, Joseba Andia Iturratea, Silvia Pérez Fernándezb, Ana Gómez Larrauria, Milagros Iriberri Pascuala
a Neumología Hospital Universitario de Cruces, Barakaldo, Vizcaya, Spain
b Biocruces-Bizkaia, Spain
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Figures (1)
Tables (4)
Table 1. Baseline data.
Table 2. Results of variables collected using the NECPAL instrument version 2.0.
Table 3. Univariate survival analysis for mortality. Hazard ratios (HR) and respective confidence intervals are displayed.
Table 4. Cox’s multivariate regression analysis for mortality.
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Abstract
Introduction

NECPAL is a tool for identification of patients with advanced chronic disease in need of palliative care. The main objective of the study is to know the prevalence of patients with palliative needs in an acute respiratory ward in a Spanish tertiary hospital using NECPAL. A second objective of the study is to know the annual mortality rate of these patients.

Materials and methods

Cross sectional study and prospective monitoring of a cohort identified as palliative patients with the NECPAL tool for 12 months. Patient identification was performed in patients admitted to the respiratory ward of our hospital for longer than 3 days. We have assessed the annual vital status (deceased or not deceased) of patients and have recorded demographics, clinical and functional data, as well as the use of healthcare resources.

Results

We monitored a cohort of 363 patients. Of them, 87 patients (24.3%) (IC 95% 19–30) were identified as NECPAL positive. 60% of patients (n = 64) died within 12 months of their admission. There was no significant difference in the mortality ratio of oncologic versus non oncologic patients. In a multivariable analysis, mortality was associated with demand by patients or relatives for palliative care and with the presence of specific disease progression markers or indicators.

Conclusions

prevalence of patients with palliative needs in acute respiratory wards is high (one out of four patients). 60% of the patients identified as NECPAL positive in our cohort died in the first 12 months. Training of healthcare professionals as well as availability of appropriate resources are indispensable factors to improve care of this population.

Keywords:
Palliative care
Chronic respiratory disease
COPD
End of life
Resumen
Introducción

El instrumento NECPAL es una herramienta para la identificación de personas en situación de enfermedad crónica avanzada con necesidades paliativas. El objetivo del estudio es conocer la prevalencia de pacientes con necesidades paliativas en un Servicio de Neumología de un hospital terciario mediante la herramienta NECPAL. Como objetivo secundario se plantea conocer la mortalidad al año de estos pacientes.

Material y métodos

Estudio trasversal y seguimiento prospectivo de la cohorte de los pacientes identificados como paliativos con la herramienta NECPAL durante 12 meses. La identificación se realiza en pacientes ingresados > 3 días en una planta de Neumología. Hemos evaluado el estatus vital (fallecido o no fallecido) al año, así como datos demográficos clínicos, funcionales y uso de recursos sanitarios.

Resultados

Se analizaron 363 pacientes. De ellos, 87 (24,3%) (IC 95%, 19–30) fueron identificados como NECPAL positivos. En el seguimiento durante un año fallecieron 54 pacientes, un 60%. No hubo diferencias en mortalidad entre diagnósticos oncológicos y no oncológicos. En el análisis multivariante, la mortalidad se asoció a la demanda de paciente o familiares de atención paliativa y a la presencia de indicadores específicos de progresión de la enfermedad.

Conclusiones

La prevalencia de pacientes con necesidades paliativas en una planta de hospitalización de agudos de Neumología es alta (uno de cada cuatro pacientes). El 60% de los identificados como NECPAL positivos en nuestra serie fallece en los primeros 12 meses. Son necesarios formación y recursos para atender a estos pacientes.

Palabras clave:
Cuidados paliativos
Enfermedad respiratoria crónica
EPOC
Final de vida

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