Rosenthal Gary E, Kaboli Peter J, Barnett Mitchell J, Sirio Carl A
Research Service, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa, USA.
J Am Geriatr Soc. 2002 Jul;50(7):1205-12. doi: 10.1046/j.1532-5415.2002.50306.x.
To determine independent relationships between age and the risk of in-hospital death.
Retrospective cohort study.
Thirty-eight intensive care units (ICUs) in 28 hospitals in a large Midwest metropolitan region.
One hundred fifty-six thousand, one hundred thirty-six consecutive admissions to medical, surgical, neurological, and mixed medical/surgical ICUs between March 1, 1991, and March 31, 1997.
In-hospital death rates were compared at successive 5-year age intervals, adjusting for gender, diagnosis, admission source, comorbidity, and acute physiology scores. Acute physiology scores were determined using a validated methodology based on abnormalities in 17 physiological measures collected during the first 24 hours of ICU admission.
The adjusted odds of death increased with each 5-year age increment. For example, relative to patients younger than 35, adjusted odds of death in patients aged 40 to 44, 50 to 54, 60 to 64, 70 to 74, 80 to 84, and 90 and older were 1.51, 1.73, 2.38, 2.98, 3.86, and 4.74, respectively. In stratified analyses, age-related increases in the odds of death were somewhat higher in surgical than medical patients or patients with lower severity of illness at admission. Although acute physiology scores had excellent discrimination in all age groups, discrimination decreased with age (e.g., c-statistics of 0.928 and 0.835 in patients younger than 45 and 85 and older, respectively).
Our findings demonstrate incremental increases in the risk of hospital death associated with age that was independent of severity of illness and other prognostic factors. Although the current results may be less biased by differences in treatment goals than studies of general hospitalized patients, the lower discrimination of physiology scores in older patients suggests that unmeasured factors (e.g., functional status, patient preferences for care, differences in physician practices) may be of greater prognostic importance in older than in younger patients.
确定年龄与住院死亡风险之间的独立关系。
回顾性队列研究。
中西部一个大都市地区28家医院的38个重症监护病房（ICU）。
1991年3月1日至1997年3月31日期间，连续入住内科、外科、神经科及内科/外科混合ICU的156,136例患者。
按连续5年的年龄间隔比较住院死亡率，并对性别、诊断、入院来源、合并症及急性生理学评分进行校正。急性生理学评分采用一种经过验证的方法确定，该方法基于ICU入院后最初24小时内收集的17项生理指标的异常情况。
校正后的死亡几率随每5年年龄增长而增加。例如，与年龄小于35岁的患者相比，年龄在40至44岁、50至54岁、60至64岁、70至74岁、80至84岁以及90岁及以上患者的校正死亡几率分别为1.51、1.73、2.38、2.98、3.86和4.74。在分层分析中，手术患者中与年龄相关的死亡几率增加幅度略高于内科患者或入院时病情较轻的患者。尽管急性生理学评分在所有年龄组中均具有良好的区分度，但区分度随年龄增长而降低（例如，年龄小于45岁和85岁及以上患者的c统计量分别为0.928和0.835）。
我们的研究结果表明，与年龄相关的住院死亡风险呈递增趋势，且独立于疾病严重程度和其他预后因素。尽管与一般住院患者的研究相比，当前结果受治疗目标差异的偏倚可能较小，但老年患者生理学评分区分度较低表明，未测量的因素（如功能状态、患者对治疗的偏好、医生治疗方式的差异）在老年患者中可能比在年轻患者中具有更大的预后重要性。
