Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
Am J Cardiol. 2018 Nov 15;122(10):1773-1778. doi: 10.1016/j.amjcard.2018.08.011. Epub 2018 Aug 22.
Older adults account for an increasing number of cardiac intensive care unit (CICU) admissions. This study sought to determine the predictive value of illness severity scores for mortality in CICU patients ≥70 years of age. Adult patients admitted to the CICU from 2007 to 2015 at one tertiary care hospital were reviewed. Severity of illness scores were calculated on the first CICU day. Area under the receiver-operator characteristic curve (AUROC) values were used to assess discrimination for hospital mortality in patients ≥70 versus <70 years of age. We included 10,004 patients with a mean age of 67.4 ± 15.2 years (37.4% female); 4,771 patients (47.7%) were ≥70 years of age. Patients ≥70 years of age had greater illness severity and more extensive co-morbidities compared with patients <70 years of age. Patients ≥70 years of age had higher hospital mortality (11.6% vs 6.8%, odds ratio 1.80, 95% confidence interval 1.57 to 2.07, p <0.001), with a progressive increase in mortality as a function of decade. Severity of illness scores had lower AUROC values for hospital mortality in patients ≥70 years of age compared with patients <70 years of age (all p <0.05 by DeLong test). The Braden skin score on CICU admission predicted hospital mortality with an AUROC value only slightly lower than these scores. Increasing age decade was associated with decreased postdischarge survival by Kaplan-Meier analysis (p <0.001 by log-rank). In conclusion, contemporary CICU patients ≥70 years of age have greater illness severity, more co-morbidities and higher mortality than patients <70 years of age, yet severity of illness scores are less accurate for predicting mortality in CICU patients ≥70 years of age, emphasizing the need for more effective risk-stratification methods in this population.
老年患者在心脏重症监护病房（CICU）的入院人数不断增加。本研究旨在确定疾病严重程度评分对 70 岁以上 CICU 患者死亡率的预测价值。回顾了一家三级保健医院 2007 年至 2015 年期间收治的 CICU 成年患者。在 CICU 的第一天计算疾病严重程度评分。使用接收者操作特征曲线（AUROC）下面积评估 70 岁以上和<70 岁患者的院内死亡率预测值。我们纳入了 10004 名平均年龄为 67.4±15.2 岁（37.4%为女性）的患者；其中 4771 名（47.7%）患者年龄≥70 岁。与<70 岁的患者相比，年龄≥70 岁的患者疾病严重程度更高，合并症更多。年龄≥70 岁的患者院内死亡率更高（11.6%vs.6.8%，比值比 1.80，95%置信区间 1.57 至 2.07，p<0.001），随着年龄的增长，死亡率呈递增趋势。与<70 岁的患者相比，疾病严重程度评分对年龄≥70 岁患者的院内死亡率的 AUROC 值较低（所有 p 值均<0.05，DeLong 检验）。CICU 入院时的Braden 皮肤评分预测院内死亡率的 AUROC 值仅略低于这些评分。Kaplan-Meier 分析显示，随着年龄的增长，出院后生存率降低（log-rank 检验 p<0.001）。总之，与<70 岁的患者相比，当代 CICU 年龄≥70 岁的患者疾病严重程度更高，合并症更多，死亡率更高，然而，疾病严重程度评分对预测年龄≥70 岁的 CICU 患者死亡率的准确性较低，强调了需要在这一人群中采用更有效的风险分层方法。
