Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia.
Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia; Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
J Am Med Dir Assoc. 2020 Apr;21(4):462-468.e7. doi: 10.1016/j.jamda.2019.12.001. Epub 2020 Jan 14.
Morbidity is an important risk factor for mortality and a variety of morbidity measures have been developed to predict patients' health outcomes. The objective of this systematic review was to compare the capacity of morbidity measures in predicting mortality among inpatients admitted to internal medicine, geriatric, or all hospital wards.
A systematic literature search was conducted from inception to March 6, 2019 using 4 databases: Medline, Embase, Cochrane, and CINAHL. Articles were included if morbidity measures were used to predict mortality (registration CRD42019126674).
Inpatients with a mean or median age ≥65 years.
Morbidity measures predicting mortality.
Of the 12,800 articles retrieved from the databases, a total of 34 articles were included reporting on inpatients admitted to internal medicine, geriatric, or all hospital wards. The Charlson Comorbidity Index (CCI) was reported most frequently and a higher CCI score was associated with greater mortality risk, primarily at longer follow-up periods. Articles comparing morbidity measures revealed that the Geriatric Index of Comorbidity was better predicting mortality risk than the CCI, Cumulative Illness Rating Scale, Index of Coexistent Disease, and disease count.
Higher morbidity measure scores are better in predicting mortality at longer follow-up period. The Geriatric Index of Comorbidity was best in predicting mortality and should be used more often in clinical practice to assist clinical decision making.
发病率是死亡率的一个重要风险因素，已经开发出多种发病率衡量标准来预测患者的健康结局。本系统评价的目的是比较发病率衡量标准在内科、老年科或所有医院病房住院患者中预测死亡率的能力。
从 2019 年 3 月 6 日开始，使用 4 个数据库（Medline、Embase、Cochrane 和 CINAHL）进行了系统的文献检索。如果发病率衡量标准用于预测死亡率（CRD42019126674 注册），则将文章纳入。
平均或中位数年龄≥65 岁的住院患者。
预测死亡率的发病率衡量标准。
从数据库中检索到的 12800 篇文章中，共有 34 篇文章纳入了报告内科、老年科或所有医院病房住院患者的研究。最常报告的是 Charlson 合并症指数（CCI），CCI 评分越高与死亡率风险增加相关，主要是在较长的随访期内。比较发病率衡量标准的文章表明，老年合并症指数比 CCI、累积疾病评分、共病指数和疾病计数更能预测死亡率风险。
较高的发病率衡量标准在较长的随访期内更能预测死亡率。老年合并症指数在预测死亡率方面表现最佳，应在临床实践中更频繁地使用，以协助临床决策。
