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老年急诊科疑似感染患者的死亡风险因素。

Risk factors for death in elderly emergency department patients with suspected infection.

作者信息

Caterino Jeffrey M, Kulchycki Lara K, Fischer Christopher M, Wolfe Richard E, Shapiro Nathan I

机构信息

Department of Emergency Medicine, Ohio State University, Columbus, Ohio, USA.

出版信息

J Am Geriatr Soc. 2009 Jul;57(7):1184-90. doi: 10.1111/j.1532-5415.2009.02320.x. Epub 2009 Jun 3.

Abstract

OBJECTIVES

To identify independent risk factors for death in elderly emergency department (ED) patients admitted for infection and to derive and validate a mortality-prediction rule for such patients.

DESIGN

Prospective cohort study.

SETTING

Tertiary hospital ED with 55,000 annual visits.

PARTICIPANTS

ED patients aged 65 and older admitted for infection between December 2003 and September 2004 in the derivation cohort and October 2005 and October 2006 in the validation cohort.

PRIMARY OUTCOME

28-day in-hospital mortality. Data were extracted from charts, and multivariate logistic regression were performed to identify independent mortality predictors. A prediction model was constructed and then validated in a second cohort.

RESULTS

Nine hundred thirty-five patients were included in the derivation cohort and 2,015 in the validation cohort. Mortality was 6% in the derivation cohort and 7% in the validation cohort. In the derivation cohort, logistic regression revealed five independent mortality predictors: respiratory compromise (respiratory rate >20 breaths per minute or hypoxemia) (odds ratio (OR)=4.0, 95% confidence interval (CI)=1.7-9.4), tachycardia (heart rate > or = 120 betas per minute; OR=3.2, 95% CI=1.6-6.3), cardiovascular failure (systolic blood pressure <90 mmHg despite fluid challenge or lactate > or = 4.0; OR=9.0, 95% CI=4.7-17), preexisting terminal illness (OR=5.7, 95% CI=2.2-15), and platelet count less than 150,000/mm3 (OR=2.7, 95% CI=1.3-5.6). Mortality increased with the number of factors: 0.51% for no factors, 3.1% for one factor, 14% for two factors, 47% for three or more risk factors. The c-statistic was 0.87 for the derivation model and 0.74 for the validation model. Almost 80% of patients in both cohorts were in low-risk groups (0 or 1 factor).

CONCLUSION

A rule derived from five readily available variables predicts mortality in infected elderly ED patients and allows identification of a large low-risk subgroup.

摘要

目的

确定因感染入院的老年急诊科患者死亡的独立危险因素,并推导和验证此类患者的死亡率预测规则。

设计

前瞻性队列研究。

地点

年就诊量达55000人次的三级医院急诊科。

参与者

推导队列中2003年12月至2004年9月以及验证队列中2005年10月至2006年10月期间因感染入院的65岁及以上老年急诊科患者。

主要结局

28天院内死亡率。从病历中提取数据,并进行多因素逻辑回归分析以确定独立的死亡预测因素。构建预测模型,然后在第二个队列中进行验证。

结果

推导队列纳入935例患者,验证队列纳入2015例患者。推导队列死亡率为6%,验证队列死亡率为7%。在推导队列中,逻辑回归分析显示五个独立的死亡预测因素:呼吸功能不全(呼吸频率>20次/分钟或低氧血症)(比值比(OR)=4.0,95%置信区间(CI)=1.7 - 9.4)、心动过速(心率≥120次/分钟;OR = 3.2,95% CI = 1.6 - 6.3)、心血管功能衰竭(尽管进行了液体复苏但收缩压<90 mmHg或乳酸≥4.0;OR = 9.0,95% CI = 4.7 - 17)、既往终末期疾病(OR = 5.7,95% CI = 2.2 - 15)以及血小板计数<150000/mm³(OR = 2.7,95% CI = 1.3 - 5.6)。死亡率随危险因素数量增加而升高:无危险因素者为0.51%,有一个危险因素者为3.1%,有两个危险因素者为14%,有三个或更多危险因素者为47%。推导模型的c统计量为0.87,验证模型的c统计量为0.74。两个队列中近80%的患者属于低风险组(0个或1个危险因素)。

结论

由五个易于获取的变量推导得出的规则可预测感染的老年急诊科患者的死亡率,并能识别出一个较大的低风险亚组。

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