Parameswaran Nair Nibu, Chalmers Leanne, Connolly Michael, Bereznicki Bonnie J, Peterson Gregory M, Curtain Colin, Castelino Ronald L, Bereznicki Luke R
Unit for Medication Outcomes Research and Education, Division of Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia.
Royal Hobart Hospital, Hobart, Tasmania, Australia.
PLoS One. 2016 Oct 31;11(10):e0165757. doi: 10.1371/journal.pone.0165757. eCollection 2016.
Adverse drug reactions (ADRs) are the major cause of medication-related hospital admissions in older patients living in the community. This study aimed to develop and validate a score to predict ADR-related hospitalization in people aged ≥65 years.
ADR-related hospitalization and its risk factors were determined using a prospective, cross-sectional study in patients aged ≥65 years admitted to two hospitals. A predictive model was developed in the derivation cohort (n = 768) and the model was applied in the validation cohort (n = 240). ADR-related hospital admission was determined through expert consensus from comprehensive reviews of medical records and patient interviews. The causality and preventability of the ADR were assessed based on the Naranjo algorithm and modified Schumock and Thornton criteria, respectively.
In the derivation sample (mean [±SD] age, 80.1±7.7 years), 115 (15%) patients were admitted due to a definite or probable ADR; 92.2% of these admissions were deemed preventable. The number of antihypertensives was the strongest predictor of an ADR followed by presence of dementia, renal failure, drug changes in the preceding 3 months and use of anticholinergic medications; these variables were used to derive the ADR prediction score. The predictive ability of the score, assessed from calculation of the area under the receiver operator characteristic (ROC) curve, was 0.70 (95% confidence interval (CI) 0.65-0.75). In the validation sample (mean [±SD] age, 79.6±7.6 years), 30 (12.5%) patients' admissions were related to definite or probable ADRs; 80% of these admissions were deemed preventable. The area under the ROC curve in this sample was 0.67 (95% CI 0.56-0.78).
This study proposes a practical and simple tool to identify elderly patients who are at an increased risk of preventable ADR-related hospital admission. Further refinement and testing of this tool is necessary to implement the score in clinical practice.
药物不良反应（ADR）是社区老年患者因用药相关原因住院的主要原因。本研究旨在开发并验证一种评分系统，以预测65岁及以上人群因ADR导致的住院情况。
采用前瞻性横断面研究，对两家医院收治的65岁及以上患者确定与ADR相关的住院情况及其危险因素。在推导队列（n = 768）中建立预测模型，并将该模型应用于验证队列（n = 240）。通过对病历的全面审查和患者访谈，经专家共识确定与ADR相关的住院情况。分别根据Naranjo算法和改良的Schumock及Thornton标准评估ADR的因果关系和可预防性。
在推导样本（平均[±标准差]年龄，80.1±7.7岁）中，115例（15%）患者因明确或可能的ADR入院；其中92.2%的入院情况被认为是可预防的。降压药的数量是ADR最强的预测因素，其次是痴呆症、肾衰竭、前3个月内药物变化以及使用抗胆碱能药物；这些变量用于推导ADR预测评分。通过计算受试者工作特征（ROC）曲线下面积评估，该评分的预测能力为0.70（95%置信区间[CI] 0.65 - 0.75）。在验证样本（平均[±标准差]年龄，79.6±7.6岁）中，30例（12.5%）患者的入院与明确或可能的ADR相关；其中80%的入院情况被认为是可预防的。该样本中ROC曲线下面积为0.67（95% CI 0.56 - 0.78）。
本研究提出了一种实用且简单的工具，用于识别因可预防的ADR相关住院风险增加的老年患者。为在临床实践中应用该评分，有必要对该工具进行进一步完善和测试。
