Department of Nursing, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China.
School of Nursing, Peking Union Medical College, Beijing, China.
PLoS One. 2020 Jan 29;15(1):e0228423. doi: 10.1371/journal.pone.0228423. eCollection 2020.
Immobility is common and associated with adverse outcomes in hospitalized patients, especially older people. However, the factors contributing to mortality in bedridden patients are not well known. This study aimed to estimate short-term mortality and analyze risk factors that affect the prognosis of bedridden patients.
This was a multicenter study in China involving 23,738 patients admitted to 25 hospitals between November 2015 and June 2016. All-cause mortality was recorded for 90 days after enrollment regardless of whether death occurred before or after discharge. Socio-demographic and clinical information was obtained from an electronic database. Univariate and multivariate Cox regression analysis was used to identify factors associated with mortality.
In total, 23,738 hospitalized bedridden patients, there were 1,114 (4.7%) observed deaths. The overall mortality rate was therefore 4.7%. Of these, 318 (1.4%) died while hospitalized and 796 (3.4%) after discharge. The univariate Cox regression analysis showed that variables significantly associated with 90-day mortality included total time spent bedridden, urinary tract infection and pulmonary infection (p<0.05). The multivariate Cox regression analysis showed that the independent risk factors for death were age (adjusted hazard ratio [aHR] 1.006, 95% CI 1.000-1.011), and pulmonary infection (aHR 1.439, 95% CI 1.266-1.635). The hazard ratios for mortality were reduced with urinary tract infection and more time spent bedridden.
The mortality after discharge was significantly higher than mortality in hospital. The factors affecting short-term mortality in bedridden patients included age, time spent bedridden, urinary tract infection and pulmonary infection. This suggests these factors may be potential predictors of mortality in bedridden patients. It is essential for medical staff to improve health education of patients and family members, pay more attention to follow up after discharge and meet care needs at home.
住院患者普遍存在活动受限的情况，且与不良预后相关，尤其是老年人。然而，导致卧床患者死亡的因素尚不清楚。本研究旨在评估短期死亡率，并分析影响卧床患者预后的危险因素。
这是一项在中国 25 家医院进行的多中心研究，共纳入 2015 年 11 月至 2016 年 6 月期间入院的 23738 例患者。无论患者是否在出院前或出院后死亡，均在入组后 90 天内记录全因死亡率。从电子数据库中获取患者的社会人口统计学和临床信息。采用单因素和多因素 Cox 回归分析确定与死亡率相关的因素。
共纳入 23738 例住院卧床患者，观察到 1114 例（4.7%）死亡。因此，总死亡率为 4.7%。其中，318 例（1.4%）在住院期间死亡，796 例（3.4%）在出院后死亡。单因素 Cox 回归分析显示，与 90 天死亡率显著相关的变量包括卧床总时间、尿路感染和肺部感染（p<0.05）。多因素 Cox 回归分析显示，死亡的独立危险因素为年龄（校正后危险比[aHR]1.006，95%CI1.000-1.011）和肺部感染（aHR1.439，95%CI1.266-1.635）。尿路感染和卧床时间较长与死亡率降低相关。
出院后死亡率明显高于住院期间死亡率。影响卧床患者短期死亡率的因素包括年龄、卧床时间、尿路感染和肺部感染。这表明这些因素可能是卧床患者死亡的潜在预测因素。医务人员有必要加强对患者及家属的健康教育，更加重视出院后的随访，满足患者居家的护理需求。
