Formiga Francesc, Ferrer Assumpta, Padros Gloria, Montero Abelardo, Gimenez-Argente Carme, Corbella Xavier
Internal Medicine Department, Geriatric Unit, Hospital Universitari de Bellvitge, Institut Català de la Salut, Barcelona, Spain; Bellvitge Biomedical Research Institute, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
Primary Care Centre "El Plà", Direcció d'Atenció Primària Costa de Ponent, Institut Català de la Salut, Sant Feliu de Llobregat, Barcelona, Spain.
Clin Interv Aging. 2016 Apr 18;11:437-44. doi: 10.2147/CIA.S101447. eCollection 2016.
To investigate the predictive value of functional impairment, chronic conditions, and laboratory biomarkers of aging for predicting 5-year mortality in the elderly aged 85 years.
Predictive value for mortality of different geriatric assessments carried out during the OCTABAIX study was evaluated after 5 years of follow-up in 328 subjects aged 85 years. Measurements included assessment of functional status comorbidity, along with laboratory tests on vitamin D, cholesterol, CD4/CD8 ratio, hemoglobin, and serum thyrotropin.
Overall, the mortality rate after 5 years of follow-up was 42.07%. Bivariate analysis showed that patients who survived were predominantly female (P=0.02), and they showed a significantly better baseline functional status for both basic (P<0.001) and instrumental (P<0.001) activities of daily living (Barthel and Lawton index), better cognitive performance (Spanish version of the Mini-Mental State Examination) (P<0.001), lower comorbidity conditions (Charlson) (P<0.001), lower nutritional risk (Mini Nutritional Assessment) (P<0.001), lower risk of falls (Tinetti gait scale) (P<0.001), less percentage of heart failure (P=0.03) and chronic obstructive pulmonary disease (P=0.03), and took less chronic prescription drugs (P=0.002) than nonsurvivors. Multivariate Cox regression analysis identified a decreased score in the Lawton index (hazard ratio 0.86, 95% confidence interval: 0.78-0.91) and higher comorbidity conditions (hazard ratio 1.20, 95% confidence interval: 1.08-1.33) as independent predictors of mortality at 5 years in the studied population.
The ability to perform instrumental activities of daily living and the global comorbidity assessed at baseline were the predictors of death, identified in our 85-year-old community-dwelling subjects after 5 years of follow-up.
探讨功能损害、慢性疾病及衰老的实验室生物标志物对预测85岁老年人5年死亡率的价值。
在OCTABAIX研究中,对328名85岁受试者进行了5年随访,评估不同老年评估指标对死亡率的预测价值。测量内容包括功能状态合并症评估,以及维生素D、胆固醇、CD4/CD8比值、血红蛋白和血清促甲状腺激素的实验室检测。
总体而言,随访5年后的死亡率为42.07%。双变量分析显示,存活患者以女性为主(P=0.02),在基本(P<0.001)和工具性(P<0.001)日常生活活动(Barthel和Lawton指数)方面,其基线功能状态明显更好,认知表现更佳(西班牙语版简易精神状态检查表)(P<0.001),合并症情况更少(Charlson)(P<0.001),营养风险更低(微型营养评定)(P<0.001),跌倒风险更低(Tinetti步态量表)(P<0.001),心力衰竭(P=0.03)和慢性阻塞性肺疾病(P=0.03)的比例更低,服用的慢性处方药更少(P=0.002)。多变量Cox回归分析确定,Lawton指数得分降低(风险比0.86,95%置信区间:0.78-0.91)和合并症情况增加(风险比1.20,95%置信区间:1.08-1.33)是研究人群5年死亡率的独立预测因素。
在我们对85岁社区居住受试者进行5年随访后发现,基线时的工具性日常生活活动能力和总体合并症情况是死亡的预测因素。