Clinical Pharmacy, Department Medical Services, Cantonal Hospital of Baden, Baden, Switzerland.
Center for Research and Innovation in Clinical Pharmaceutical Sciences, University Hospital and University of Lausanne, Lausanne, Switzerland.
Basic Clin Pharmacol Toxicol. 2022 Feb;130(2):288-300. doi: 10.1111/bcpt.13692. Epub 2021 Dec 6.
Although no gold standard exists to assess a patient's anticholinergic burden, a review identified 19 anticholinergic burden scales (ABSs). No study has yet evaluated whether a high anticholinergic burden measured with all 19 ABSs is associated with in-hospital mortality and length of stay (LOS). We conducted a cohort study at a Swiss tertiary teaching hospital using patients' electronic health record data from 2015-2018. Included were patients aged ≥65 years, hospitalised ≥48 h without stays and >24 h in intensive care. Patients' cumulative anticholinergic burden score was classified using a binary (<3: low, ≥3: high) and categorical approach (0: no, 0.5-3: low, ≥3: high). In-hospital mortality and LOS were analysed using multivariable logistic and linear regression, respectively. We included 27,092 patients (mean age 78.0 ± 7.5 years, median LOS 6 days). Of them, 913 died. Depending on the evaluated ABS, 1370 to 17,035 patients were exposed to anticholinergics. Patients with a high burden measured by all 19 ABSs were associated with a 1.32- to 3.03-fold increase in in-hospital mortality compared with those with no/low burden. We obtained similar results for LOS. To conclude, discontinuing drugs with anticholinergic properties (score ≥3) at admission might be a targeted intervention to decrease in-hospital mortality and LOS.
尽管评估患者抗胆碱能负担尚无金标准，但已有综述确定了 19 种抗胆碱能负担量表（ABS）。尚无研究评估用所有 19 种 ABS 测量的高抗胆碱能负担是否与住院死亡率和住院时间（LOS）相关。我们在瑞士一家三级教学医院进行了一项队列研究，使用了 2015 年至 2018 年患者的电子健康记录数据。纳入标准为年龄≥65 岁、住院时间≥48 小时且无住院时间和≥24 小时的重症监护。患者的累积抗胆碱能负担评分采用二分类（<3：低，≥3：高）和分类法（0：无，0.5-3：低，≥3：高）进行分类。采用多变量逻辑回归和线性回归分别分析住院死亡率和 LOS。我们纳入了 27092 名患者（平均年龄 78.0±7.5 岁，中位 LOS 6 天）。其中 913 人死亡。根据评估的 ABS，有 1370 至 17035 名患者暴露于抗胆碱能药物。与无/低负担相比，所有 19 种 ABS 测量的高负担患者的住院死亡率增加了 1.32 至 3.03 倍。我们在 LOS 方面也得到了类似的结果。总之，入院时停止使用具有抗胆碱能特性的药物（评分≥3）可能是降低住院死亡率和 LOS 的有针对性干预措施。
