Mayer-Oakes S A, Oye R K, Leake B
UCLA Department of Medicine 90024-1687.
J Am Geriatr Soc. 1991 Sep;39(9):862-8. doi: 10.1111/j.1532-5415.1991.tb04452.x.
We examined predictors of hospital and 6-month mortality in older Medical Intensive Care Unit (MICU) patients with particular attention to age and functional status. Age is generally thought to be strongly associated with intensive care outcomes, but this relationship may be confounded by age-related changes. These age-related changes may be approximated by changes in functional status (FS).
We conducted a retrospective chart review and collected severity of illness data using the Acute Physiology Score (APS), pre-hospitalization FS dichotomized as limited or not limited, and hospital mortality. County death records were reviewed for 6-month mortality.
Three community hospital MICUs.
Four-hundred MICU patients aged 50 and older admitted during the study period.
Limited FS was found in 42% of the 227 patients who had FS data in the chart. Mortality was significantly associated with APS, age, FS, immunocompromise state, comorbidity, and nursing home residence. In logistic regression analyses, while controlling for important variables, APS (P less than 0.001) and age greater than or equal to 75 with limited FS (P less than 0.05) were associated with hospital mortality. Six-month mortality predictors were APS (P less than 0.001), hospital (P less than 0.05), immunocompromised state (P less than 0.05) and age greater than or equal to 75 with limited FS (P less than 0.05).
We found that among patients without functional limitations, the oldest group was no more likely to die than the youngest group. Age and functional status had a significant interaction: patients older than 75 years with functional limitations were almost six times more likely to die in hospital compared to the reference group of patients between 50-64 years old without functional limitations. We conclude that functional status is an important predictor of outcome in older MICU patients.
我们研究了老年医学重症监护病房（MICU）患者的医院死亡率及6个月死亡率的预测因素，尤其关注年龄和功能状态。一般认为年龄与重症监护结果密切相关，但这种关系可能会因年龄相关变化而混淆。这些年龄相关变化可能可以通过功能状态（FS）的变化来近似体现。
我们进行了一项回顾性病历审查，并使用急性生理学评分（APS）收集疾病严重程度数据，将入院前功能状态分为受限或不受限，并记录医院死亡率。查阅县死亡记录以获取6个月死亡率。
三家社区医院的MICU。
研究期间收治的400名年龄在50岁及以上的MICU患者。
在病历中有FS数据的227名患者中，42%的患者功能状态受限。死亡率与APS、年龄、FS、免疫功能低下状态、合并症及养老院居住情况显著相关。在逻辑回归分析中，在控制重要变量的同时，APS（P<0.001）以及功能状态受限且年龄大于或等于75岁（P<0.05）与医院死亡率相关。6个月死亡率的预测因素为APS（P<0.001）、住院情况（P<0.05）、免疫功能低下状态（P<0.05）以及功能状态受限且年龄大于或等于75岁（P<0.05）。
我们发现，在没有功能限制的患者中，年龄最大的组并不比年龄最小的组更易死亡。年龄和功能状态存在显著交互作用：与50 - 64岁无功能限制的参考组患者相比，功能受限的75岁以上患者在医院死亡的可能性几乎高出六倍。我们得出结论，功能状态是老年MICU患者预后的重要预测因素。
