Sousa Sílvia, Moraes M F, Beato V, Corredoura A S, Rodrigues G, Soares M, Lourenço T, Gomes C, Godinho F, Oliveira L, Santos A P, Soares C, Ribeiro T P, Jordão L, Menitra G, Aguiar P, Graça J Pimenta, Abecasis P
Serviço de Medicina Interna, Hospital de Egas Moniz, Lisboa.
Acta Med Port. 2002 May-Jun;15(3):177-84.
This article presents the results of a prospective multivariable study of elderly patients aged over 70 years, hospitalized in an Internal Medicine Department of a Central Lisbon Hospital. The study aimed to identify, at the beginning of hospital admission (HA), predictive factors of hospital mortality (HM) and mortality at 6 months, of duration of HA, of admission to a nursing home at the time of discharge and during a period of 6 months thereafter and of hospital readmission during the 6 months following discharge. The study included 158 patients with a mean hospital stay of 15 days and a hospital mortality of 12%. The main pathologies responsible for hospital admission were cerebrovascular accident (22%), heart failure (20%) and pneumonia (16%). Mortality at 6 months was 29% and hospital readmission in the 6 months thereafter was 24%. When the patient was cared for by the spouse there was a statistically significant correlation with a shorter duration of admission (p = 0.006). Mean hospital stay was not significantly associated with any other variable. A subjective medical evaluation (SME) at the start of HA (p = 0.001), a low Barthel score prior to and at the time of HA, low serum albumin (p = 0.001) and a high leucocyte count (p = 0.005) were correlated with a higher HM. Nursing home admission was only positively correlated with cerebrovascular pathology. Mortality at 6 months was significantly correlated with the SME (p = 0.001), a low Barthel score prior to admission (p < 0.008) and at the time of HA (p < 0.001), nursing home residency (p < 0.005) and a low mental test score (p < 0.01). Hospital readmission at 6 months was influenced by the SME (p < 0.04) and by the reduction in the Barthel score caused by the illness and HA (p = 0.004). These correlations enabled the development of mathematical models that predict HM and mortality at 6 months and admission to a nursing home at the time of discharge and during a period of 6 months thereafter. They could be important in identifying elderly patients' needs early in the hospital admission and in the improvement of the strategy necessary for a successful and dignified hospital discharge.
本文介绍了一项针对70岁以上老年患者的前瞻性多变量研究结果，这些患者在里斯本中心医院的内科住院。该研究旨在确定在入院时（HA）医院死亡率（HM）、6个月死亡率、HA持续时间、出院时及此后6个月内入住养老院情况以及出院后6个月内再次入院的预测因素。该研究纳入了158例患者，平均住院时间为15天，医院死亡率为12%。导致入院的主要疾病为脑血管意外（22%）、心力衰竭（20%）和肺炎（16%）。6个月时的死亡率为29%，此后6个月内的再次入院率为24%。当患者由配偶照顾时，与住院时间较短存在统计学显著相关性（p = 0.006）。平均住院时间与任何其他变量均无显著关联。HA开始时的主观医学评估（SME）（p = 0.001）、HA之前及当时的低Barthel评分、低血清白蛋白（p = 0.001）和高白细胞计数（p = 0.00）与较高的HM相关。入住养老院仅与脑血管疾病呈正相关。6个月时的死亡率与SME（p = 0.001）、入院前（p < 0.008）及HA时的低Barthel评分（p < 0.001）、养老院居住情况（p < 0.005）和低心理测试评分（p < 0.01）显著相关。6个月时的再次入院受SME（p < 0.04）以及疾病和HA导致的Barthel评分降低（p = 0.004）影响。这些相关性使得能够开发出预测HM、6个月死亡率以及出院时及此后6个月内入住养老院情况的数学模型。它们对于在入院早期识别老年患者的需求以及改善成功且体面出院所需的策略可能具有重要意义。
