Desbiens et al identified factors associated with high symptom burdens for hospitalized patients who are seriously ill. These can help identify patients who may benefit from closer monitoring and more aggressive interventions to improve the patient's quality of life. The authors are from the Marshfield Clinic and four other American university hospitals.


Factors associated with a high symptom burden:

(1) number of significant comorbidities

(2) number of dependencies in activities of daily living (ADL) prior to hospitalization

(3) quality of life

(4) disease group


Being hospitalized might also be viewed as a risk factor affecting symptom burden ("seriously ill patients have a high symptom burden").


Other factors listed as associated with symptom burden:

(5) gender (male > female)

(6) study hospital


Symptoms viewed as most burdensome:

(1) dyspnea

(2) pain

(3) nausea

(4) anxiety

(5) depression


Disease groups associated with high symptom burdens (enrollment in the study was limited to a specified list of common diseases with high mortality):

(1) lung cancer

(2) chronic obstructive lung disease (COPD)

(3) sepsis with acute respiratory failure

(4) sepsis with multiple organ failure

(5) malignancy with multiple organ failure


Male gender was listed as a risk factor for high symptom burden. Since dyspnea was one of the major symptoms and the disease groups with the highest burden have a respiratory component, I wonder if this could be related to a higher prevalence of smoking (and drinking) in men. Another consideration is that men might be more willing to complain.


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