Takahashi Paul Y, Cha Stephen S, Kiemele Lester J
Kogod Program on Aging, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Int Wound J. 2008 Dec;5(5):625-31. doi: 10.1111/j.1742-481X.2008.00542.x.
Chronic ulcers are a common problem in long-term care. Residents with ongoing ulcers are often frail and at risk for mortality. This study evaluated the relationship between wound characteristics and other health predictors with 6-month mortality in nursing home residents. The subjects included were nursing home residents seen by the wound consult service from 1998 to 2007 with an ongoing chronic ulcer. This was a retrospective cohort study. Data were manually and electronically abstracted for each resident. Six-month mortality was collected as the primary outcome. Statistical comparisons were made using logistic regression with a final multivariant model. Four hundred and forty residents were seen with 411 records reviewed. Ulcer area was not associated with mortality; however, chronic ulcer number was associated with 6-month mortality with an odds ratio of 1.32 (95% CI 1.07-1.63). Other significant risk factors included heart failure, dementia, cancer, depression and blindness with all factors having an odds ratio greater than 1.75. Higher haemoglobin and venous insufficiency were protective of 6-month mortality. Ulcer number is an important predictor for 6-month mortality. The presence of multiple ulcers and comorbid health concerns may influence discussion of prognosis for healing and for potential end of life discussions.
慢性溃疡是长期护理中的常见问题。患有持续性溃疡的居民通常身体虚弱，有死亡风险。本研究评估了伤口特征和其他健康预测因素与养老院居民6个月死亡率之间的关系。纳入的研究对象为1998年至2007年期间接受伤口咨询服务的患有持续性慢性溃疡的养老院居民。这是一项回顾性队列研究。针对每位居民手动和电子提取数据。收集6个月死亡率作为主要结局。采用逻辑回归和最终多变量模型进行统计比较。共诊治440名居民，审查了411份记录。溃疡面积与死亡率无关；然而，慢性溃疡数量与6个月死亡率相关，比值比为1.32（95%可信区间1.07 - 1.63）。其他显著风险因素包括心力衰竭、痴呆、癌症、抑郁症和失明，所有这些因素的比值比均大于1.75。较高的血红蛋白水平和静脉功能不全对6个月死亡率具有保护作用。溃疡数量是6个月死亡率的重要预测因素。多个溃疡的存在以及合并的健康问题可能会影响关于愈合预后和潜在临终讨论。
