Department of Medicine, University Campus Bio-Medico, Rome, Italy.
Department of Medicine, University Campus Bio-Medico, Rome, Italy.
Eur J Intern Med. 2018 Aug;54:60-64. doi: 10.1016/j.ejim.2018.04.001. Epub 2018 Apr 9.
The estimated glomerular filtration rate (eGFR) is a predictor of important outcomes and its reduction has been associated with the risk of all-cause mortality in both general population and elderly patients. However while reduced renal function is common in older people, the best method for estimating GFR remains unclear, especially in an acute care setting. Most studies analyzing the accuracy of eGFR in the elderly were carried out in different heterogeneous settings. In this study, we compare the prognostic value of different formulas estimating GFR in predicting the risk of in-hospital morbidity and mortality within 3 months from discharge in elderly hospitalized patients. Data were extracted from "Registro Politerapia Società Italiana di Medicina Interna (REPOSI)". Patients with available creatinine values at hospital admission were selected and eGFR was calculated according to the different formulas: Cockcroft-Gault, Modification of Diet in Renal Disease equation, Chronic Kidney Disease Epidemiology Collaboration, Berlin Initiative Study and Full Age Spectrum. 4621 patients were included in the analysis. Among these, 4.2% and 14.2% died during hospitalization and within 3 months from discharge, respectively. eGFR > 60 ml/min/1.73 m at admission was associated with a very low risk of mortality during the hospital stay and within 90 days from discharge, while an eGFR < 60 ml/min/1.73 m was associated with unfavorable outcomes, although with a poor level of accuracy (AUC 0.60-0.66). No difference in predictive power between different equations was found. Physicians should be aware of the prognostic role of eGFR in a comprehensive assessment of elderly in-patients.
估算肾小球滤过率（eGFR）是重要结局的预测指标，其降低与全因死亡率风险相关，这在一般人群和老年患者中均成立。然而，虽然老年人中肾功能降低较为常见，但估计 GFR 的最佳方法仍不明确，尤其是在急性护理环境中。大多数分析 eGFR 在老年人中准确性的研究是在不同的异质环境中进行的。在这项研究中，我们比较了不同公式估计 GFR 在预测出院后 3 个月内住院发病率和死亡率风险方面的预后价值，这些公式适用于老年住院患者。数据从 "Registro Politerapia Società Italiana di Medicina Interna (REPOSI)" 中提取。选择了入院时可获得肌酐值的患者，并根据不同公式计算 eGFR：Cockcroft-Gault、肾脏病饮食改良公式、慢性肾脏病流行病学协作、柏林倡议研究和全年龄谱。共纳入 4621 例患者。其中，4.2%和 14.2%分别在住院期间和出院后 3 个月内死亡。入院时 eGFR > 60 ml/min/1.73 m 与住院期间和出院后 90 天内的死亡率极低相关，而 eGFR < 60 ml/min/1.73 m 与不良结局相关，尽管准确性较差（AUC 0.60-0.66）。不同方程之间的预测能力没有差异。医生应该意识到 eGFR 在老年住院患者综合评估中的预后作用。
