Abstract
BACKGROUND: High CHA(2)DS(2)-VASc score (Congestive heart failure, Hypertension, Age > 75 years, Diabetes mellitus, prior Stroke or transient ischemic attack or thromboembolism, Vascular disease, Age 65-74 and Sex category) was associated with adverse clinical outcomes in different settings. The aim of the present study was to evaluate the association between CHA(2)DS(2)-VASc score and R(2)CHA(2)DS(2)-VASc score (which includes renal impairment) with in-hospital mortality and length of hospital stay in patients hospitalized in an internal medicine ward. METHODS: We enrolled 983 consecutive patients admitted during 3 years in an internal medicine ward. R(2)CHA(2)DS(2)-VASc score was calculated by adding 2 points to CHA(2)DS(2)-VASc for the presence of chronic kidney disease (CKD), defined according to K-DOQI. The primary outcome was a composite of all-cause mortality and length of hospital stay > 10 days. RESULTS: Patients with CKD stages 3-5 presented with increased CHA(2)DS(2)-VASc vs stages 1-2 (p < 0.001). The composite outcome occurred in 47.3% of inpatients. Multivariable linear logistic regression analyses adjusted for presence of infectious diseases and cancer, with the occurrence of composite outcome showed an adjusted OR of 1.349 (95% CI 1.248-1.462) and 1.254 (95% CI 1.179-1.336) for CHA(2)DS(2)-VASc and R(2)CHA(2)DS(2)-VASc scores, respectively. No differences were found in the association between CHA(2)DS(2)-VASc and R(2)CHA(2)DS(2)-VASc scores with the composite outcome (AUC 0.631 vs 0.630), and furthermore, adding the presence/absence of infectious diseases during hospitalization and positive cancer history to the models increased the AUC (0.667 and 0.663). CONCLUSIONS: Incrementally higher CHA(2)DS(2)-VASc score is associated with increased length of hospital stay and mortality in patients hospitalized in an internal medicine ward, regardless of the presence of CKD.