Buurman Bianca M, Frenkel Wijnanda J, Abu-Hanna Ameen, Parlevliet Juliette L, de Rooij Sophia E
Academic Medical Center, Department of Internal Medicine, Section of Geriatric Medicine, University of Amsterdam, Amsterdam, The Netherlands.
Academic Medical Center, Department of Internal Medicine, Section of Vascular medicine, University of Amsterdam, Amsterdam, The Netherlands.
Eur J Intern Med. 2016 Jan;27:68-75. doi: 10.1016/j.ejim.2015.09.021. Epub 2015 Oct 21.
To describe the prevalence of multimorbidity and to study the association between acute and chronic diseases in acutely hospitalized older patients
Prospective cohort study conducted between 2006 and 2008 in three teaching hospitals in the Netherlands. 639 patients aged 65 years and older, hospitalized for >48 h were included. Two physicians scored diseases, using ICD-9 codes. Chronic multimorbidity was defined as the presence of ≥2 chronic diseases, and acute multimorbidity as ≥1 acute diseases upon pre-existent chronic diseases. Logistic regression analyses were conducted to analyse cluster associations between a chronic index disease and the concurrent chronic or acute disease, corrected for age and sex.
The mean age of patients was 78 years, over 50% had ADL impairments. Prevalence of chronic multimorbidity was 69%, and acute multimorbidity was present in 88%. Hypertension (OR 1.16; 95% CI 1.08-1.24), diabetes (type I or type 2) (OR 1.12; 95% CI 1.04-1.21), heart failure (OR 1.25; 95% CI 1.14-1.38) and COPD (OR 1.19; 95% CI 1.05-1.34) were associated with acute renal failure. Hypertension (OR 1.10; 95% CI 1.04-1.17) and atrial fibrillation (OR 1.17; 95% CI 1.08-1.27) were associated with an adverse drug event. Gastro-intestinal bleeding was clustered with atrial fibrillation (OR 1.11; 95% CI 1.04-1.19) and gastric ulcer (OR 1.16; 95% CI 1.07-1.25).
Both acute and chronic multimorbidity was frequently present in hospitalized older patients. We identified specific associations between acute and chronic diseases. There is a need for strategies addressing multimorbidity during the exacerbation of chronic diseases.
描述多重疾病的患病率，并研究急性住院老年患者中急性疾病与慢性疾病之间的关联
2006年至2008年在荷兰的三家教学医院进行前瞻性队列研究。纳入639名65岁及以上、住院时间超过48小时的患者。两名医生使用国际疾病分类第九版（ICD - 9）编码对疾病进行评分。慢性多重疾病定义为存在≥2种慢性疾病，急性多重疾病定义为在已有慢性疾病基础上存在≥1种急性疾病。进行逻辑回归分析，以分析慢性指标疾病与并发的慢性或急性疾病之间的聚类关联，并对年龄和性别进行校正。
患者的平均年龄为78岁，超过50%的患者存在日常生活活动能力障碍。慢性多重疾病的患病率为69%，急性多重疾病的患病率为88%。高血压（比值比[OR] 1.16；95%置信区间[CI] 1.08 - 1.24）、糖尿病（1型或2型）（OR 1.12；95% CI 1.04 - 1.21）、心力衰竭（OR 1.25；95% CI 1.14 - 1.38）和慢性阻塞性肺疾病（COPD）（OR 1.19；95% CI 1.05 - 1.34）与急性肾衰竭相关。高血压（OR 1.10；95% CI 1.04 - 1.17）和心房颤动（OR 1.17；95% CI 1.08 - 1.27）与药物不良事件相关。胃肠道出血与心房颤动（OR 1.11；95% CI 1.04 - 1.19）和胃溃疡（OR 1.16；95% CI 1.07 - 1.25）聚集。
住院老年患者中急性和慢性多重疾病均很常见。我们确定了急性疾病与慢性疾病之间的特定关联。在慢性疾病加重期间，需要采取应对多重疾病的策略。
