急性住院高龄患者出院后死亡率的未被充分重视的预测因素。

Underappreciated predictors for postdischarge mortality in acute hospitalized oldest-old patients.

作者信息

Iwata Mitsunaga, Kuzuya Masafumi, Kitagawa Yoshimi, Suzuki Yusuke, Iguchi Akihisa

机构信息

Department of Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.

出版信息

Gerontology. 2006;52(2):92-8. doi: 10.1159/000090954.

DOI:10.1159/000090954

PMID:16508316

Abstract

BACKGROUND

Although oldest-old, those aged 85 years and older, patients are the fastest growing segment, clinical evidences regarding the acute care of oldest-old patients are still lacking. Because acute medical conditions requiring emergent hospitalization is frequently followed by high rate of progressive physical decline and increased mortality after discharge in oldest-old patients, prognostic information collected during hospitalization can provide the basis for discussion about the goals of care and therapy. The aim of our study was to identify predictive factors for postdischarge mortality in oldest-old patients.

METHODS

The study included 403 oldest-old patients discharged from the acute care setting of a general hospital, who were followed-up for 1 year. Predictive values of the patients' characteristics collected during their hospitalization for 1-year mortality were identified utilizing Cox proportional hazard regression analysis.

RESULTS

During 1-year follow-up, 104 patients (25.8%) died. The variables independently associated with 1-year mortality in multivariate analysis were the Charlson Comorbidity Index equal or greater than 2 [HR (hazard ratio) 4.71, 95%CI (confidence interval) 1.09-20.42], six or more prescribed medications at discharge (HR 3.12, 95% CI 1.39-6.99), benzodiazepines use (HR 1.64, 95% CI 1.04-2.60), nonsteroidal anti-inflammatory drugs use (HR 1.70, 95% CI 1.10-2.63), albumin less than or equaling 3.4 g/dl (HR 2.16, 95% CI 1.13-4.14), hemoglobin 10-12 g/dl (HR 2.32, 95% CI 1.22-3.56), hemoglobin less than 10 g/dl (HR 2.67, 95% CI 1.43-4.95), the presence of pressure sores (HR 1.84, 95% CI 1.14-2.97), and a history of delirium (HR 2.24, 95% CI 1.32-3.79). Functional impairment assessed by the Katz Index was only weakly associated with mortality (HR 1.24, 95% CI 0.53-2.91).

CONCLUSION

Although often underappreciated, polypharmacy, particular medication use, anemia, the presence of pressure sores, and a history of delirium were important predictors for postdischarge mortality in oldest-old patients.

摘要

背景

尽管高龄老人（85岁及以上）患者是增长最快的群体，但关于高龄老人急性护理的临床证据仍然不足。由于需要紧急住院治疗的急性疾病在高龄老人患者中常常随后出现较高的身体功能逐渐衰退率和出院后死亡率增加的情况，住院期间收集的预后信息可为讨论护理和治疗目标提供依据。我们研究的目的是确定高龄老人患者出院后死亡的预测因素。

方法

该研究纳入了403例从综合医院急性护理科室出院的高龄老人患者，并对其进行了1年的随访。利用Cox比例风险回归分析确定住院期间收集的患者特征对1年死亡率的预测价值。

结果

在1年的随访期间，104例患者（25.8%）死亡。多变量分析中与1年死亡率独立相关的变量包括：Charlson合并症指数等于或大于2[风险比（HR）4.71，95%置信区间（CI）1.09 - 20.42]、出院时开具六种或更多药物（HR 3.12，95% CI 1.39 - 6.99）、使用苯二氮䓬类药物（HR 1.64，95% CI 1.04 - 2.60）、使用非甾体抗炎药（HR 1.70，95% CI 1.10 - 2.63）、白蛋白小于或等于3.4 g/dl（HR 2.16，95% CI 1.13 - 4.14）、血红蛋白10 - 12 g/dl（HR 2.32，95% CI 1.22 - 3.56）、血红蛋白小于10 g/dl（HR 2.67，95% CI 1.43 - 4.95）、存在压疮（HR 1.84，95% CI 1.14 - 2.97）以及谵妄病史（HR 2.24，95% CI 1.32 - 3.79）。通过Katz指数评估的功能障碍与死亡率仅存在微弱关联（HR 1.24，95% CI 0.53 - 2.91）。