A simple score (BECLAP Score) is accurate in predicting early mortality in frail medical non-oncologic patients, and may help physicians to identify management priorities.

Prognosis has a central role in clinical decision-making, but most studies address medium-long term prognosis, e.g. mortality at 1 year. Still what is crucial in clinical decisions is short-term prognosis, i.e. 3-months mortality, that was not addressed previously as primary outcome in prognostic studies. Indeed, life expectancy of three months is now deemed a condition in which palliative care should be considered, activating appropriate protocols.
In a prospective observational study (Brucato et al. Eur J Int Med 2019 [Epub ahead of print]) 2788 consecutive patients admitted in 5 Italian Internal Medicine units were prospectively screened; 644 oncologic patients were excluded; 2144 non-oncologic patients (1021 female) were followed-up for mortality for 6 months. Main outcome was 3-months mortality in permanently bedridden inpatients with at least 2 of: creatinine clearance <35 ml/min; albumin <2.5 mg/dl; at least 2 hospital admissions in the previous 6 months. Advanced dementia and dysphagia were also recorded.
Approximately two out of three non-oncologic medical patients permanently bedridden having 2 of the abovementioned items were dead 3 months after index admission.

A simple score was calculated in a training cohort and validated in validation cohort. The BECLAP-D score is a validated score that includes just 6 very SIMPLE items:

1. AGE
2. SEX
3. TO BE OR NOT PERMANENTLY BEDRIDDEN
4. the value of calculated CREATININE CLEARANCE
5. The ALBUMIN value
6. presence or absence of clinically relevant DYSPHAGIA

This score accurately predicts the probability of mortality at 3 months in frail non-oncologic patients permanently bedridden, and may be very useful in discussing management priorities.