日本接受心肺复苏的老年住院患者生存相关预测因素：一项观察性队列研究。
Predictors Associated with Survival Among Elderly In-Patients Who Receive Cardiopulmonary Resuscitation in Japan: An Observational Cohort Study.
机构信息
Division of Clinical Epidemiology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
Division of Clinical Epidemiology, The Jikei University School of Medicine, Tokyo, Japan.
出版信息
J Gen Intern Med. 2019 Feb;34(2):206-210. doi: 10.1007/s11606-018-4747-5. Epub 2018 Nov 27.
BACKGROUND
Little is known about the outcomes of in-hospital cardiopulmonary resuscitation (CPR) in Asian populations including elderly patients in Japan.
OBJECTIVE
To determine the survival outcome of in-hospital CPR among elderly patients in Japan, and to identify predictors associated with survival.
DESIGN
Retrospective cohort study in 81 Japanese hospitals from April 1, 2010 to March 31, 2016.
PATIENTS
We included elderly patients (age ≥ 65 years) who received CPR after 2 days of hospitalization.
MAIN MEASURES
The primary outcome was survival at hospital discharge and the secondary outcomes were the discharge disposition and consciousness level of patients who survived to hospital discharge. To determine predictors associated with survival after in-hospital CPR, we fit multivariable models for patient-level and institutional-level factors.
KEY RESULTS
Among the 5365 patients who received CPR, 595 (11%) survived to discharge. Of those who survived to discharge, 46% of patients were discharged home, and 10% of patients were comatose at discharge. Older age and higher burden of comorbidities were associated with reduced survival. The adjusted OR was 0.35 (95% CI, 0.22-0.55) for age ≥ 90 years compared to age 65-69 years, and 0.68 (95% CI, 0.48-0.97) for Charlson Comorbidity Index score of ≥ 4 compared with score of 0. Other predictors of reduced survival included receiving CPR on weekends compared to weekdays (AOR, 0.63; 95% CI, 0.51-0.77) and in small hospitals compared to large hospitals (AOR, 0.58; 95% CI, 0.40-0.83).
CONCLUSIONS
Among elderly patients in Japan, the survival rate of in-hospital CPR was approximately one in ten, and less than half of these patients were discharged home. In addition to older age and higher illness burden, receiving CPR on weekends and/or in small hospitals were significant predictors of reduced survival. These findings should be considered in advanced care planning discussions with elderly patients to avoid subjecting patients to CPR that are likely futile.
背景
在包括日本在内的亚洲人群中，有关院内心肺复苏（CPR）的结果知之甚少，包括老年患者。
目的
确定日本老年患者院内 CPR 的生存结果，并确定与生存相关的预测因素。
设计
2010 年 4 月 1 日至 2016 年 3 月 31 日在 81 家日本医院进行的回顾性队列研究。
患者
我们纳入了住院后 2 天内接受 CPR 的老年患者（年龄≥65 岁）。
主要观察指标
主要结局为出院时的生存情况，次要结局为存活至出院的患者出院时的处理情况和意识水平。为确定与院内 CPR 后生存相关的预测因素，我们针对患者和机构层面的因素拟合了多变量模型。
主要结果
在接受 CPR 的 5365 名患者中，有 595 名（11%）存活至出院。在存活至出院的患者中，46%的患者出院回家，10%的患者出院时处于昏迷状态。年龄较大和合并症负担较高与生存率降低相关。与年龄 65-69 岁相比，年龄≥90 岁的调整后 OR 为 0.35（95%CI，0.22-0.55），Charlson 合并症指数评分≥4 分与评分 0 分相比，OR 为 0.68（95%CI，0.48-0.97）。生存率降低的其他预测因素包括周末接受 CPR 与工作日（AOR，0.63；95%CI，0.51-0.77）和小医院接受 CPR 与大医院（AOR，0.58；95%CI，0.40-0.83）相比。
结论
在日本老年患者中，院内 CPR 的生存率约为十分之一，其中不到一半的患者出院回家。除了年龄较大和合并症负担较重外，周末和/或在小医院接受 CPR 也是生存率降低的显著预测因素。在与老年患者进行高级护理计划讨论时，应考虑到这些发现，以避免对可能无效的 CPR 进行治疗。
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