El-Sharkawy Ahmed M, Watson Phillip, Neal Keith R, Ljungqvist Olle, Maughan Ron J, Sahota Opinder, Lobo Dileep N
Gastrointestinal Surgery, National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, UK.
School of Exercise and Health Sciences, Loughborough University, Leicestershire LE11 3TU, UK.
Age Ageing. 2015 Nov;44(6):943-7. doi: 10.1093/ageing/afv119. Epub 2015 Aug 26.
Older adults are susceptible to dehydration due to age-related pathophysiological changes. We aimed to investigate the prevalence of hyperosmolar dehydration (HD) in hospitalised older adults, aged ≥65 years, admitted as an emergency and to assess the impact on short-term and long-term outcome.
This prospective cohort study was performed on older adult participants who were admitted acutely to a large U.K. teaching hospital. Data collected included the Charlson comorbidity index (CCI), national early warning score (NEWS), Canadian Study of Health and Aging (CSHA) clinical frailty scale and Nutrition Risk Screening Tool (NRS) 2002. Admission bloods were used to measure serum osmolality. HD was defined as serum osmolality >300 mOsmol/kg. Participants who were still in hospital 48 h after admission were reviewed, and the same measurements were repeated.
A total of 200 participants were recruited at admission to hospital, 37% of whom were dehydrated. Of those dehydrated, 62% were still dehydrated when reviewed at 48 h after admission. Overall, 7% of the participants died in hospital, 79% of whom were dehydrated at admission (P = 0.001). Cox regression analysis adjusted for age, gender, CCI, NEWS, CSHA and NRS demonstrated that participants dehydrated at admission were 6 times more likely to die in hospital than those euhydrated, hazards ratio (HR) 6.04 (1.64-22.25); P = 0.007.
HD is common in hospitalised older adults and is associated with poor outcome. Coordinated efforts are necessary to develop comprehensive hydration assessment tools to implement and monitor a real change in culture and attitude towards hydration in hospitalised older adults.
由于与年龄相关的病理生理变化，老年人易发生脱水。我们旨在调查≥65岁因急诊入院的老年住院患者中高渗性脱水（HD）的患病率，并评估其对短期和长期预后的影响。
这项前瞻性队列研究针对的是急性入住一家大型英国教学医院的老年参与者。收集的数据包括查尔森合并症指数（CCI）、国家早期预警评分（NEWS）、加拿大健康与老龄化研究（CSHA）临床衰弱量表和营养风险筛查工具（NRS）2002。入院时采集的血液用于测量血清渗透压。HD定义为血清渗透压>300 mOsmol/kg。对入院48小时后仍住院的参与者进行复查，并重复相同的测量。
共招募了200名入院患者，其中37%存在脱水。在这些脱水患者中，62%在入院后48小时复查时仍处于脱水状态。总体而言，7%的参与者在医院死亡，其中79%在入院时处于脱水状态（P = 0.001）。经年龄、性别、CCI、NEWS、CSHA和NRS校正的Cox回归分析表明，入院时脱水的参与者在医院死亡的可能性是未脱水参与者的6倍，风险比（HR）为6.04（1.64 - 22.25）；P = 0.007。
HD在老年住院患者中很常见，且与不良预后相关。有必要共同努力开发全面的水化评估工具，以实施和监测对老年住院患者水化的文化和态度的实际转变。
