Brown Siobhan H, Flint Katie, Storey Allison, Abdelhafiz Ahmed H
Department of Elderly Medicine, Rotherham General Hospital, Rotherham, UK.
Hosp Pract (1995). 2012 Feb;40(1):193-201. doi: 10.3810/hp.2012.02.960.
To explore whether routinely assessed biochemical markers tested on admission will predict 3 predefined adverse outcomes for hospitalized elderly patients: discharge to a long-term care facility, in-hospital mortality, and prolonged hospital length of stay (> 14 days).
A prospective observational study of elderly patients (aged ≥ 75 years) admitted to an acute-care geriatric ward over a 6-month period. Patients were assessed on admission and baseline characteristics were collected. Activities of daily living were assessed by the Barthel Index and cognitive function by the abbreviated mental test. Results from biochemical markers tested on admission were downloaded from the pathology laboratory database using patient details. Patients were followed-up with until discharge or in-hospital mortality.
A total of 392 patients formed the study population. Mean (standard deviation) age was 83.2 (± 5.5) years and 283 (72%) patients were men. Thirty-eight (10%) patients were discharged to a long-term care facility, 134 (34%) had a prolonged hospital length of stay, and 33 (8%) died in the hospital. Results from testing 5 biochemical markers independently predicted in-hospital mortality: hypoalbuminemia (adjusted odds ratio [OR], 2.5; 95% CI, 0.9-6.7; P = 0.04), low total cholesterol level (adjusted OR, 2.9; 95% CI, 1.3-6.3; P = 0.01), hyperglycemia (adjusted OR, 2.9; 95% CI, 1.2-7.4; P = 0.02), high C-reactive protein level (adjusted OR, 4.2; 95% CI, 1.3-13.4; P = 0.01), and renal impairment (adjusted OR, 3.8; 95% CI, 1.7-8.7; P = 0.002). High C-reactive protein level independently predicted prolonged hospital length of stay (OR, 1.7; 95% CI, 1.1-2.9; P = 0.03). Hypoalbuminemia predicted discharge to a long-term care facility independent of confounding factors except for physical dysfunction (OR, 2.4; 95% CI, 1.1-5.1; P = 0.03). Significance was reduced after adjustment for Barthel Index score (OR, 1.9; 95% CI, 0.9-4.1; P = 0.08).
Testing of routinely assessed biochemical markers on admission predicted adverse hospital outcomes for elderly patients. Their inclusion in a standardized prediction tool may help to create interventions to improve such outcomes.
探讨入院时常规检测的生化指标能否预测老年住院患者3种预先定义的不良结局：转至长期护理机构、院内死亡和住院时间延长（>14天）。
对一家急性护理老年病房6个月内收治的老年患者（年龄≥75岁）进行前瞻性观察研究。患者入院时接受评估并收集基线特征。采用巴氏指数评估日常生活活动能力，采用简易精神状态检查表评估认知功能。利用患者详细信息从病理实验室数据库下载入院时检测的生化指标结果。对患者进行随访直至出院或院内死亡。
共有392例患者构成研究人群。平均（标准差）年龄为83.2（±5.5）岁，283例（72%）患者为男性。38例（10%）患者转至长期护理机构，134例（34%）患者住院时间延长，33例（8%）患者在医院死亡。检测5种生化指标的结果独立预测了院内死亡：低白蛋白血症（调整优势比[OR]，2.5；95%置信区间[CI]，0.9 - 6.7；P = 0.04）、总胆固醇水平低（调整OR，2.9；95% CI，1.3 - 6.3；P = 0.01）、高血糖（调整OR，2.9；95% CI，1.2 - 7.4；P = 0.02）、高C反应蛋白水平（调整OR，4.2；95% CI，1.3 - 13.4；P = 0.01）和肾功能损害（调整OR，3.8；95% CI , 1.7 - 8.7；P = 0.002）。高C反应蛋白水平独立预测住院时间延长（OR，1.7；95% CI，1.1 - 2.9；P = 0.03）。低白蛋白血症预测转至长期护理机构，独立于除身体功能障碍外的混杂因素（OR，2.4；95% CI，1.1 - 5.1；P = 0.03）。调整巴氏指数评分后显著性降低（OR，1.9；95% CI，0.9 - 4.1；P = 0.08）。
入院时常规检测的生化指标可预测老年患者的不良住院结局。将其纳入标准化预测工具可能有助于制定干预措施以改善此类结局。
