Unit of Geriatric Medicine, IRCCS INRCA, Cosenza, Italy.
Department of Clinical and Experimental Medicine, University of Messina, University of Messina, Messina, Italy.
Eur J Intern Med. 2021 Nov;93:57-63. doi: 10.1016/j.ejim.2021.06.031. Epub 2021 Jul 10.
Interactions between chronic kidney disease (CKD) and several comorbidities may potentially affect prognosis of older hospitalized patients. This study aims at evaluating the prognostic interactions between estimated glomerular filtration rate (eGFR), anemia, sarcopenia, functional and cognitive dysfunction, and 3-year mortality among older patients discharged from acute care hospitals.
Our series consisted of 504 older adults enrolled in a multicenter observational study carried out in twelve Acute Geriatric and Internal Medicine wards throughout Italy. CKD was defined as an eGFR< 60 ml/min/1.73 m. Anemia, Short Portable Status Mental Questionnaire (SPMSQ), Basic Activities of Daily Living (BADL), sarcopenia, and Charlson index were considered in the analysis. 3-year survival was investigated by Cox regression and prognostic interactions among study variables were assessed by survival tree analysis. Accuracy of different survival models was investigated by C-index.
eGFR < 30 mL/min/1.73 m, anemia, sarcopenia, SPMSQ ≥ 5, and impairment in 1 or more BADL were significantly associated with mortality. Survival tree analysis showed that patients with eGFR < 35.32 ml/min/1.73 m and SPMSQ ≥ 5 had the highest risk of mortality [hazard ratio (HR): 5.49, 95%CI: 3.04-9.94] followed by those with eGFR < 35.32 ml/min/1.73 m, hemoglobin < 11.95 g/dL and SPMSQ < 5 (HR:3.65; 95%CI: 2.21-6.02) and those with eGFR 35.32-47.99 ml/min/1.73 m and sarcopenia (HR:3.65; 95%CI: 1.99-6.69). Survival tree leaf node membership had good accuracy in predicting the study outcome (C-index: 0.73, 95%CI:0.70-0.76).
Interactions among study risk factors designed distinct risk profiles in older patients discharged from acute care hospitals, that may help identify patients needing targeted interventions and appropriate follow-up after discharge.
慢性肾脏病（CKD）和几种合并症之间的相互作用可能会影响老年住院患者的预后。本研究旨在评估肾小球滤过率（eGFR）、贫血、肌肉减少症、功能和认知功能障碍之间的预后相互作用，并评估 3 年死亡率在从急性护理医院出院的老年患者中的作用。
我们的研究系列包括 504 名参加在意大利 12 个急性老年病和内科病房进行的多中心观察性研究的老年人。CKD 的定义为 eGFR<60 ml/min/1.73 m。在分析中考虑了贫血、短 portable 状态精神问卷（SPMSQ）、基本日常生活活动（BADL）、肌肉减少症和 Charlson 指数。通过 Cox 回归研究了 3 年生存率，并通过生存树分析评估了研究变量之间的预后相互作用。通过 C 指数研究了不同生存模型的准确性。
eGFR<30 ml/min/1.73 m、贫血、肌肉减少症、SPMSQ≥5 和 1 项或多项 BADL 受损与死亡率显著相关。生存树分析显示，eGFR<35.32 ml/min/1.73 m 和 SPMSQ≥5 的患者死亡率最高[危险比（HR）：5.49，95%CI：3.04-9.94]，其次是 eGFR<35.32 ml/min/1.73 m、血红蛋白<11.95 g/dL 和 SPMSQ<5（HR：3.65；95%CI：2.21-6.02）和 eGFR 35.32-47.99 ml/min/1.73 m 和肌肉减少症（HR：3.65；95%CI：1.99-6.69）。生存树叶节点成员对预测研究结果具有良好的准确性（C 指数：0.73，95%CI：0.70-0.76）。
在从急性护理医院出院的老年患者中，研究危险因素之间的相互作用设计了不同的风险特征，这可能有助于识别需要有针对性干预和出院后适当随访的患者。
