***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: UNLABELLED Both nadolol and ligation have proved to be effective in the prophylaxis of first variceal bleeding .  This study was conducted to evaluate the effects and safety of combining nadolol with ligation .  Cirrhotic patients with high-risk esophageal varices but without a bleeding history were considered for enrolment . Eligible patients were r and omized to receive b and ligation plus nadolol ( Combined group , 70 patients ) or nadolol alone ( Nadolol group , 70 patients ) . In the Combined group multiligators were applied . Patients received regular ligation treatment at an interval of 4 weeks until variceal obliteration . Nadolol was administered at a dose to reduce 25 % of the pulse rate in both the Combined group and the Nadolol group . Both groups were comparable in baseline data . In the Combined group 50 patients ( 71 % ) achieved variceal obliteration . The mean dose of nadolol was 52 + /- 16 mg in the Combined group and 56 + /- 19 mg in the Nadolol group . During a median follow-up of 26 months , 18 patients ( 26 % ) in the Combined group and 13 patients ( 18 % ) in the Nadolol group experienced upper gastrointestinal bleeding ( P = NS ) . Esophageal variceal bleeding occurred in 10 patients ( 14 % ) in the Combined group and nine patients ( 13 % ) in the Nadolol group ( P = NS ) . Adverse events were noted in 48 patients ( 68 % ) in the Combined group and 28 patients ( 40 % ) in the Nadolol group ( P = 0.06 ) . Sixteen patients in each group died . CONCLUSION The addition of ligation to nadolol may increase adverse events and did not enhance effectiveness in the prophylaxis of first variceal bleeding OBJECTIVES We sought to evaluate the effects of carvedilol on mortality and morbidity in dialysis patients with dilated cardiomyopathy . BACKGROUND Several lines of evidence support the concept that therapy with beta-blocking agents reduces morbidity and mortality in patients with congestive heart failure ( HF ) , but the demonstration of such a survival benefit in dialysis patients with dilated cardiomyopathy is still lacking . METHODS A total of 114 dialysis patients with dilated cardiomyopathy were r and omized to receive either carvedilol or placebo in addition to st and ard therapy . A first analysis was performed at one year and was followed by an additional follow-up period of 12 months . RESULTS Two-year echocardiographic data revealed a significant attenuation of pathologic remodeling , with smaller cavity diameters and higher ejection fractions in the active treatment group than in the placebo group . At two years , 51.7 % of the patients died in the carvedilol group , compared with 73.2 % in the placebo group ( p < 0.01 ) . Furthermore , there were significantly fewer cardiovascular deaths ( 29.3 % ) and hospital admissions ( 34.5 % ) among patients receiving carvedilol than among those receiving a placebo ( 67.9 % and 58.9 % , respectively ; p < 0.00001 ) . The exploratory analyses revealed that fatal myocardial infa rct ions , fatal strokes , and hospital admissions for worsening HF were lower in the carvedilol group than in the placebo group . A reduction in sudden deaths and pump-failure deaths was also observed , though it did not reach statistical significance . CONCLUSIONS Carvedilol reduced morbidity and mortality in dialysis patients with dilated cardiomyopathy . These data suggest the use of carvedilol in all dialysis patients with chronic HF Factors determining in-hospital mortality and long-term survival of patients hospitalised with acute exacerbations of chronic obstructive pulmonary disease ( AE COPD ) are not precisely understood . The aim of the present study was to assess the parameters related to in-hospital mortality and long-term survival after hospitalisation of patients with AE COPD . Clinical and epidemiological parameters on admission in 205 consecutive patients hospitalised with AE COPD were prospect ively assessed . Patients were followed-up for 3 yrs . Factors determining short- and long-term mortality were analysed . In total , 17 patients ( 8.3 % ) died in hospital . In-hospital mortality was significantly associated with lower arterial oxygen tension ( Pa , O2 ) , higher carbon dioxide arterial tension , lower arterial oxygen saturation and longer hospital stay . The overall 6-month mortality rate was 24 % , with 1- , 2- and 3-yr mortality rates of 33 % , 39 % and 49 % , respectively . Cox regression analysis revealed that long-term mortality was associated with longer disease duration ( relative risk ( RR ) = 1.158 ) , lower albumin ( RR = 0.411 ) , lower Pa , O2 ( RR = 0.871 ) and lower body mass index ( RR = 0.830 ) . When the model was run for the time elapsed since first hospitalisation , it also appeared as statistically significant ( RR = 1.195 ) . These findings show that patients hospitalised with acute exacerbations of chronic obstructive pulmonary disease have poor short- and long-term survival . Prediction of survival status may be enhanced by considering arterial oxygen tension , albumin , body mass index , disease duration and time elapsed since the first hospitalisation CONTEXT Estimating life expectancy is challenging in advanced dementia , potentially limiting the use of hospice care in these patients . OBJECTIVE To prospect ively vali date and compare the performance of the Advanced Dementia Prognostic Tool ( ADEPT ) and hospice eligibility guidelines to estimate 6-month survival in nursing home residents with advanced dementia . DESIGN , SETTING , AND PARTICIPANTS A prospect i ve cohort study conducted in 21 nursing homes in Boston , Massachusetts , of 606 residents with advanced dementia who were recruited between November 1 , 2007 , and July 30 , 2009 . Data were ascertained at baseline to determine the residents ' ADEPT score ( range , 1.0 - 32.5 ; higher scores indicate worse prognosis ) and whether they met Medicare hospice eligibility guidelines . Survival was followed up to 6 months . MAIN OUTCOME MEASURES Assessment and comparison of the performance of the ADEPT score and hospice guidelines to predict 6-month survival using sensitivity , specificity , and the area under the receiver operating characteristic ( AUROC ) curve . RESULTS At baseline , the residents ' mean ( SD ) ADEPT score was 10.1 ( 3.1 ) points and 65 residents ( 10.7 % ) met hospice eligibility guidelines . Over 6 months , 111 residents ( 18.3 % ) died . The AUROC for the ADEPT score 's prediction of 6-month mortality as a continuous variable was 0.67 ( 95 % confidence interval [ CI ] , 0.62 - 0.72 ) . The AUROC for Medicare hospice eligibility guidelines was 0.55 ( 95 % CI , 0.51 - 0.59 ) , the specificity was 0.89 ( 95 % CI , 0.86 - 0.92 ) , and the sensitivity was 0.20 ( 95 % CI , 0.13 - 0.28 ) . Using a cutoff of 13.5 on the ADEPT score , which also had specificity of 0.89 , the AUROC was 0.58 ( 95 % CI , 0.54 - 0.63 ) and the sensitivity was 0.27 ( 95 % CI , 0.19 - 0.36 ) . CONCLUSIONS When prospect ively vali date d at the bedside and used as a continuous measure , the ability of the ADEPT score to identify nursing home residents with advanced dementia at high risk of death within 6 months was modest , albeit better than hospice eligibility guidelines . Care provided to these residents should be guided by their goals of care rather than estimated life expectancy BACKGROUND Malnutrition is prevalent in elderly population s. Recommended methods of nutritional screening are often too complicated and time-consuming for routine application in frail , very old , hospitalized patients . OBJECTIVE Our aims were to identify risk factors for development of malnutrition in very old hospitalized patients and to evaluate the total  Mini Nutritional Assessment ( MNA ) score and MNA subscores as predictors of in-hospital and long-term mortality . DESIGN A prospect i ve cohort study of patients aged > or = 75 y was conducted in a geriatric hospital . Assessment included demographic , clinical , and laboratory data and cognitive , functional , and nutritional status . Follow-up was conducted for < or = 2.7 y. RESULTS Of the 414 patients studied , only 73 ( 17.6 % ) were well-nourished . Low serum albumin and phosphorus concentrations , dementia , and cerebrovascular accident ( CVA ) were significant risk factors for malnutrition . Survival was significantly lower in malnourished patients and patients at risk of malnutrition than in well-nourished patients ( P < 0.0001 ) . Low MNA-3 subscores ( dietary habits )  were significantly correlated with laboratory indexes of malnutrition and were significantly lower in patients with infections , malignancy , pressure ulcers , dementia , recent orthopedic surgery , and CVA . Multivariate analysis showed that a low MNA-3 score was an independent predictor of mortality ; scores < 7.5 increased the risk of death 2.05-fold . CONCLUSIONS The prevalence of malnutrition was high in elderly hospitalized patients . Dietary habits were significant predictors of poor hospitalization outcome . A question naire on dietary habits can serve as a useful tool in assessing nutritional status and prognosis in elderly patients BACKGROUND / AIM Hepatorenal syndrome ( HRS ) is associated with a poor prognosis . The incidence and prognostic impact of kidney dysfunction due to other causes in cirrhotic patients are less well known . The current study prospect ively evaluated the incidence and the prognostic relevance of different etiologies of kidney failure in cirrhotic patients . METHODS Eighty-eight consecutive patients with cirrhosis and serum creatinine > or = 1.5 mg/dl were enrolled . The etiologies of kidney dysfunction were analyzed , and prognostic factors including  Model for End-Stage Liver Disease ( MELD ) score were evaluated in a multivariate Cox model . RESULTS HRS was present in 35 ( 40 % ) patients ( 15 HRS 1 , 20 HRS 2 ) , followed by renal parenchymal disease ( 23 % ) , drug-induced kidney dysfunction ( 19 % ) and prerenal failure due to bleeding or infections ( 15 % ) . HRS patients had a significantly higher MELD score and shorter survival . In addition to the MELD score , only HRS 1 was independently predictive for survival . HRS 2 patients had a similar outcome as patients with non-HRS kidney dysfunction . CONCLUSIONS In patients with cirrhosis and renal failure , hepatorenal syndrome is associated with a worse prognosis than kidney dysfunction due to other conditions but only HRS type 1 has independent prognostic relevance in addition to the MELD score in these patients BACKGROUND A supplemented very-low-protein diet ( sVLPD ) seems to be safe when postponing dialysis therapy . STUDY DESIGN Prospect i ve multicenter r and omized controlled study design ed to assess the noninferiority of diet versus dialysis in 1-year mortality assessed by using intention-to-treat and per- protocol analysis . SETTING & PARTICIPANTS Italian uremic patients without diabetes older than 70 years with glomerular filtration rate of 5 to 7 mL/min ( 0.08 to 0.12 mL/s ) . INTERVENTION R and omization to an sVLPD ( diet group ) or dialysis . The sVLPD is a vegan diet ( 35 kcal ; proteins , 0.3 g/kg body weight daily ) supplemented with keto-analogues , amino acids , and vitamins . Patients following an sVLPD started dialysis therapy in the case of malnutrition , intractable fluid overload , hyperkalemia , or appearance of uremic symptoms . OUTCOMES & MEASUREMENTS Mortality , hospitalization , and metabolic markers . RESULTS 56 patients were r and omly assigned to each group , median follow-up was 26.5 months ( interquartile range , 40 ) , and patients in the diet group spent a median of 10.7 months ( interquartile range , 11 ) following an sVLPD . Forty patients in the diet group started dialysis treatment because of either fluid overload or hyperkalemia . There were 31 deaths ( 55 % ) in the dialysis group and 28 deaths ( 50 % ) in the diet group . One-year observed survival rates at intention to treat were 83.7 % ( 95 % confidence interval [ CI ] , 74.5 to 94.0 ) in the dialysis group versus 87.3 % ( 95 % CI , 78.9 to 96.5 ) in the diet group ( log-rank test for noninferior 
    Output:
    
Even though advanced noncancer syndromes differ clinical ly , a universal set of prognostic factors signals progression to terminal disease , including poor performance status , advanced age , malnutrition , comorbid illness , organ dysfunction , and hospitalization for acute decompensation .
Generally , a 6-month median survival is associated with the presence of 2 - 4 of these factors .
With few exceptions , these terminal presentations are quite refractory to treatment .
There is little evidence at present that treatment prolongs survival at these terminal stages