Triana Cuervo Pablo Andrés, Ocampo-Chaparro José Mauricio, Reyes-Ortiz Carlos A, Casanova María Eugenia
Departamento de Medicina Interna, Universidad Libre, Cali, Colombia.
Departamento de Medicina Interna, Universidad Libre, Cali, Colombia; Departamento de Medicina Familiar, Universidad del Valle, Cali, Colombia.
Rev Esp Geriatr Gerontol. 2019 Sep-Oct;54(5):265-271. doi: 10.1016/j.regg.2019.04.006. Epub 2019 Jun 10.
To determine the relationship between estimated glomerular filtration rate (eGFR) and mortality in a retrospective cohort of older adults admitted to an acute care for the elderly (ACE) unit.
The study included 1,678 patients aged 60 years and over admitted to an AEC, in Cali, Colombia, from 2012 to 2015, and followed- up until 2016. The primary outcome was mortality. Renal function (eGFR) was estimated using Modification of Diet in Renal Disease Study (MDRD-4) equation. The renal function was grouped according to the eGFR (ml/min/1.73m) as follows: slightly decreased (≥60), moderately decreased (30-59), and severely decreased (<30). Bivariate survival and multivariate Cox regression analyses were performed.
In the univariate analysis, patients with severely decreased eGFR had higher mortality than those with a higher eGFR (P=.046). In the group with severely decreased eGFR, survival was lower in the functionally dependent group (Barthel index [IB]<60) than in the independent group (IB≥60) (log rank test; P=.001). In the multivariate analysis, there was a significant increase in the risk of death in the elderly with severely decreased eGFR (<30) compared with slightly decreased eGFR (≥60) (hazard ratio [HR], 1.44; 95% confidence interval [CI]; 1.02-2.05, P=.039). There was also a significant increase in the risk of death in the dependent elderly compared to the independent ones [HR 1.72; 95% CI; 1.26-2.34, P=.000], those who had the high morbidity (≥4) with low albumin (<3.2g/dL) compared with those with low morbidity (0-3) and high albumin (≥3.2) [HR 1.77; 95% CI; 1.18-2.65, P=.005], and in those with a high (16-102mg/dL) C-reactive protein (CRP) compared with those with low CRP (0-15) [HR 1.42; 95% CI; 1.01-2.01, P=.043].
The risk of mortality after hospital admission to an AEC unit is greater in patients with eGFR<30. Poor functional status performance, high comorbidity, low plasma albumin, and increased inflammation markers are additional prognostic factors to be taken into account. The improvement in the functional status could improve the survival after hospitalisation.
在一个入住老年急性护理（ACE）病房的老年回顾性队列中，确定估算肾小球滤过率（eGFR）与死亡率之间的关系。
该研究纳入了2012年至2015年期间在哥伦比亚卡利市入住AEC病房的1678例60岁及以上患者，并随访至2016年。主要结局是死亡率。使用肾脏病膳食改良研究（MDRD-4）方程估算肾功能（eGFR）。根据eGFR（ml/min/1.73m²）将肾功能分组如下：轻度下降（≥60）、中度下降（30 - 59）和重度下降（<30）。进行了双变量生存分析和多变量Cox回归分析。
在单变量分析中，eGFR重度下降的患者死亡率高于eGFR较高的患者（P = 0.046）。在eGFR重度下降组中，功能依赖组（Barthel指数[IB]<60）的生存率低于独立组（IB≥60）（对数秩检验；P = 0.001）。在多变量分析中，与eGFR轻度下降（≥60）的老年人相比，eGFR重度下降（<30）的老年人死亡风险显著增加（风险比[HR]，1.44；95%置信区间[CI]：1.02 - 2.05，P = 0.039）。与独立老年人相比，依赖老年人的死亡风险也显著增加[HR 1.72；95% CI：1.26 - 2.34，P = 0.000]，与低发病率（0 - 3）和高白蛋白（≥3.2）的患者相比，高发病率（≥4）且低白蛋白（<3.2g/dL）的患者死亡风险增加[HR 1.77；95% CI：1.18 - 2.65，P = 0.005]，与低C反应蛋白（CRP）（0 - 15）的患者相比，高CRP（16 - 102mg/dL）的患者死亡风险增加[HR 1.42；95% CI：1.01 - (此处原文有误，应为2.01)，P = 0.043]。
入住AEC病房后，eGFR<30的患者死亡风险更大。功能状态差表现、高合并症、低血浆白蛋白和炎症标志物升高是需要考虑的额外预后因素。功能状态的改善可提高住院后的生存率。
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