Ali Sheraz, Peterson Gregory M, Bereznicki Luke R, Salahudeen Mohammed S
King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia.
Discipline of Pharmacy, School of Medicine, University of Tasmania, Hobart, 7005, Australia.
Eur J Clin Pharmacol. 2020 Mar;76(3):319-335. doi: 10.1007/s00228-019-02795-x. Epub 2019 Dec 12.
The purpose of the study is to conduct a systematic review of studies examining the association between anticholinergic burden and mortality in older individuals.
A literature search was performed to identify relevant studies, using MEDLINE, EMBASE, PsycINFO and CENTRAL, from January 1990 to December 2018. We included studies of patients with a mean age of 65 years or older where the anticholinergic burden was estimated using anticholinergic risk assessment tools, and associations between anticholinergic load and mortality were investigated. The primary outcome of interest was the association between anticholinergic burden and mortality.
Twenty-seven studies were included. These were three cross-sectional, one nested case-control and 23 prospective or retrospective cohort studies. Most studies were determined to be of good quality. A total of 15 studies reported a positive correlation between anticholinergic burden and mortality, while the remaining 10 studies did not report a significant association. Eighteen out of 27 studies (80%) had a short follow-up period of 1 year or less. Among the five high-quality studies that met all the domains of the quality assessment criteria, four showed a positive association.
The variation in results could relate to the quality of the studies, follow-up period, anticholinergic risk assessment tool used and the study setting. Sixty-three percent (n = 17) of all the included studies, but almost all of the high-quality studies with an extended follow-up, reported a positive correlation between anticholinergic burden and mortality. Further high-quality research, using standardized measures and with adequate follow-up periods, is required to confirm the relationship between anticholinergic burden and mortality.
本研究旨在对考察老年人抗胆碱能负担与死亡率之间关联的研究进行系统综述。
利用MEDLINE、EMBASE、PsycINFO和CENTRAL数据库，检索1990年1月至2018年12月期间的相关研究。我们纳入了平均年龄在65岁及以上患者的研究，这些研究使用抗胆碱能风险评估工具来估计抗胆碱能负担，并调查了抗胆碱能负荷与死亡率之间的关联。主要关注的结果是抗胆碱能负担与死亡率之间的关联。
共纳入27项研究。其中有3项横断面研究、1项巢式病例对照研究以及23项前瞻性或回顾性队列研究。多数研究被判定质量良好。共有15项研究报告抗胆碱能负担与死亡率之间存在正相关，而其余10项研究未报告显著关联。27项研究中有18项（80%）随访期较短，为1年或更短。在符合质量评估标准所有领域的5项高质量研究中，有4项显示存在正相关。
结果的差异可能与研究质量、随访期、所使用的抗胆碱能风险评估工具以及研究背景有关。所有纳入研究中有63%（n = 17），但几乎所有随访期延长的高质量研究，均报告抗胆碱能负担与死亡率之间存在正相关。需要开展进一步的高质量研究，采用标准化测量方法并具备足够的随访期，以确认抗胆碱能负担与死亡率之间的关系。
