Arcanjo Suelen Pereira, Saporetti Luis Alberto, Curiati José Antonio Esper, Jacob-Filho Wilson, Avelino-Silva Thiago Junqueira
Faculdade de Medicina, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil.
Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Einstein (Sao Paulo). 2018;16(1):eAO4092. doi: 10.1590/s1679-45082018ao4092. Epub 2018 Apr 23.
Objective To investigate clinical and laboratory characteristics associated with referral of acutely ill older adults to exclusive palliative care. Methods A retrospective cohort study based on 572 admissions of acutely ill patients aged 60 years or over to a university hospital located in São Paulo, Brazil, from 2009 to 2013. The primary outcome was the clinical indication for exclusive palliative care. Comprehensive geriatric assessments were used to measure target predictors, such as sociodemographic, clinical, cognitive, functional and laboratory data. Stepwise logistic regression was used to identify independent predictors of palliative care. Results Exclusive palliative care was indicated in 152 (27%) cases. In the palliative care group, in-hospital mortality and 12 month cumulative mortality amounted to 50% and 66%, respectively. Major conditions prompting referral to palliative care were advanced dementia (45%), cancer (38%), congestive heart failure (25%), stage IV and V renal dysfunction (24%), chronic obstructive pulmonary disease (8%) and cirrhosis (4%). Major complications observed in the palliative care group included delirium (p<0.001), infections (p<0.001) and pressure ulcers (p<0.001). Following multivariate analysis, male sex (OR=2.12; 95%CI: 1.32-3.40), cancer (OR=7.36; 95%CI: 4.26-13.03), advanced dementia (OR=12.6; 95%CI: 7.5-21.2), and albumin levels (OR=0.25; 95%CI: 0.17-0.38) were identified as independent predictors of referral to exclusive palliative care. Conclusion Advanced dementia and cancer were the major clinical conditions associated with referral of hospitalized older adults to exclusive palliative care. High short-term mortality suggests prognosis should be better assessed and discussed with patients and families in primary care settings.
目的 探讨与急性病老年患者转诊至专科姑息治疗相关的临床和实验室特征。方法 一项回顾性队列研究，基于2009年至2013年巴西圣保罗一家大学医院收治的572例60岁及以上急性病患者。主要结局是专科姑息治疗的临床指征。采用综合老年评估来测量目标预测因素，如社会人口学、临床、认知、功能和实验室数据。采用逐步逻辑回归来确定姑息治疗的独立预测因素。结果 152例（27%）患者被建议接受专科姑息治疗。在姑息治疗组中，住院死亡率和12个月累积死亡率分别为50%和66%。促使转诊至姑息治疗的主要疾病是晚期痴呆（45%）、癌症（38%）、充血性心力衰竭（25%）、IV期和V期肾功能不全（24%）、慢性阻塞性肺疾病（8%）和肝硬化（4%）。姑息治疗组观察到的主要并发症包括谵妄（p<0.001）、感染（p<0.001）和压疮（p<0.001）。多因素分析后，男性（OR=2.12；95%CI：1.32-3.40）、癌症（OR=7.36；95%CI：4.26-13.03）、晚期痴呆（OR=12.6；95%CI：7.5-21.2）和白蛋白水平（OR=0.25；95%CI：0.17-0.38）被确定为转诊至专科姑息治疗的独立预测因素。结论 晚期痴呆和癌症是与住院老年患者转诊至专科姑息治疗相关的主要临床疾病。短期高死亡率表明应在初级保健环境中更好地评估预后并与患者及其家属进行讨论。
