Predictors of in-hospital death among patients referred to a hospital-based palliative care team: a retrospective cohort study

Abstract

Abstract Background Hospital-based specialist palliative care (HSPC) teams are increasingly involved in the care of patients with advanced illness admitted to acute hospitals. However, a substantial proportion of patients referred to HSPC die during the index hospitalization. This study aims to assess the rate of in-hospital mortality among patients referred to an HSPC consultation service and to identify independent predictors of in-hospital death at the time of referral. Methods We conducted a retrospective cohort study of adult patients referred to an in-hospital HSPC consultation service in a tertiary care hospital between 1st March 2022 and 31st December 2024. The primary outcome was death during the index hospitalization. Clinical and demographic variables recorded at referral were analysed using univariable and multivariable logistic regression. Model discrimination was assessed using the area under the receiver operating characteristic curve (AUC). Results A total of 1,142 patients were included (median age 75 years; 56.7% male), of whom 343 (30.0%) died during index hospitalization. The strongest predictors of in-hospital death were bedridden status (OR 5.54), delirium (OR 2.73), assisted/chairbound status (OR 2.52), onco-hematological diagnosis (OR 1.87), and non-oncological diagnosis (OR 1.47). Dyspnea was associated with increased mortality, whereas fatigue and weight loss showed an inverse association. Model discrimination was satisfactory (AUC 0.769). Conclusions Among patients referred to HSPC, in-hospital death was primarily driven by motor dependency, delirium, onco-hematological and non-oncological diagnoses and delayed referral. These findings suggest that simple bedside clinical and functional variables, routinely available at the time of first HSPC consultation, may support prognostic stratification of in-hospital mortality in acute care settings.