Division of Geriatric Medicine, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jl. Diponegoro No.71, Salemba, Jakarta, Indonesia.
Clinical Epidemiology and Evidence Based Medicine Unit, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
BMC Geriatr. 2021 Apr 17;21(1):256. doi: 10.1186/s12877-021-02198-7.
Readmission is related to high cost, high burden, and high risk for mortality in geriatric patients. A scoring system can be developed to predict the readmission of older inpatients to perform earlier interventions and prevent readmission.
We followed prospectively inpatients aged 60 years and older for 30 days, with initial comprehensive geriatric assessment (CGA) on admission in a tertiary referral centre. Patients were assessed with CGA tools consisting of FRAIL scale (fatigue, resistance, ambulation, illness, loss of weight), the 15-item Geriatric Depression Scale, Mini Nutritional Assessment short-form (MNA-SF), the Barthel index for activities of daily living (ADL), Charlson Comorbidity Index (CCI), caregiver burden based on 4-item Zarit Burden Index (ZBI), and cognitive problem with Abbreviated Mental Test (AMT). Demographic data, malignancy diagnosis, and number of drugs were also recorded. We excluded data of deceased patients and patients transferred to other hospitals. We conducted stepwise multivariate regression analysis to develop the scoring system.
Thirty-day unplanned readmission rate was 37.6 %. Among 266 patients, 64.7 % of them were malnourished, and 46.5 % of them were readmitted. About 24 % were at risk for depression or having depressed mood, and 53.1 % of them were readmitted. In multivariate analysis, nutritional status (OR 2.152, 95 %CI 1.151-4.024), depression status (OR 1.884, 95 %CI 1.071-3.314), malignancy (OR 1.863 95 %CI 1.005-3.451), and functional status (OR 1.584, 95 %CI 0.885-2.835) were included in derivation of 7 score system. The scoring system had maximum score of 7 and incorporated malnutrition (2 points), depression (2 points), malignancy (2 points), and dependent functional status (1 point). A score of 3 or higher suggested 82 % probability of readmission within 30 days following discharge. Area under the curve (AUC) was 0.694 (p = 0.001).
Malnutrition, depression, malignancy and functional problem are predictors for 30-day readmission. A practical CGA-based 7 scoring system had moderate accuracy and strong calibration in predicting 30-day unplanned readmission for older patients.
再入院与老年患者的高成本、高负担和高死亡率有关。可以开发一种评分系统来预测老年住院患者的再入院，以便进行早期干预并预防再入院。
我们前瞻性地随访了年龄在 60 岁及以上的住院患者，在一家三级转诊中心进行入院时的综合老年评估（CGA）。患者接受了 CGA 工具的评估，包括 FRAIL 量表（疲劳、抵抗力、活动、疾病、体重减轻）、15 项老年抑郁量表、微型营养评估简短表（MNA-SF）、日常生活活动（ADL）的巴氏量表、Charlson 合并症指数（CCI）、基于 4 项 Zarit 负担指数（ZBI）的照顾者负担以及认知问题的简短精神状态测试（AMT）。还记录了人口统计学数据、恶性肿瘤诊断和药物数量。我们排除了死亡患者和转院患者的数据。我们进行了逐步多元回归分析来开发评分系统。
30 天非计划性再入院率为 37.6%。在 266 名患者中，64.7%的患者存在营养不良，46.5%的患者再入院。约 24%的患者有抑郁或情绪低落的风险，其中 53.1%的患者再入院。在多变量分析中，营养状况（OR 2.152，95%CI 1.151-4.024）、抑郁状况（OR 1.884，95%CI 1.071-3.314）、恶性肿瘤（OR 1.863，95%CI 1.005-3.451）和功能状态（OR 1.584，95%CI 0.885-2.835）被纳入了 7 分制评分系统的推导中。该评分系统的最高得分为 7 分，包括营养不良（2 分）、抑郁（2 分）、恶性肿瘤（2 分）和依赖性功能状态（1 分）。得分 3 分或以上提示出院后 30 天内再入院的概率为 82%。曲线下面积（AUC）为 0.694（p=0.001）。
营养不良、抑郁、恶性肿瘤和功能问题是 30 天再入院的预测因素。一种实用的基于 CGA 的 7 分制评分系统具有中等的准确性和强大的校准能力，可预测老年患者 30 天内非计划性再入院。
