认知功能及中枢神经系统抑制剂的使用对死亡率的影响——一项针对既往住院老年患者的前瞻性观察研究

The effect of cognitive function and central nervous system depressant use on mortality-A prospective observational study of previously hospitalised older patients.

作者信息

Siddiqui Tahreem Ghazal, Bjelkarøy Maria Torheim, Cheng Socheat, Kristoffersen Espen Saxhaug, Grambaite Ramune, Lundqvist Christofer

机构信息

Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog, Norway.

Institute of Clinical medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.

出版信息

PLoS One. 2022 Mar 3;17(3):e0263024. doi: 10.1371/journal.pone.0263024. eCollection 2022.

DOI:10.1371/journal.pone.0263024

PMID:35239678

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8893618/

Abstract

BACKGROUND

Older patients are often users of prolonged Central Nervous System Depressants (CNSD) (Z-hypnotics, benzodiazepines and opioids), which may be associated with reduced cognition. The long-term effects of CNSD use and reduced cognitive function in older patients are unclear. The aim of this study was to examine whether cognitive function and CNSD use at baseline hospitalisation were associated with all-cause mortality two years after discharge.

METHODS

We conducted a prospective observational study, including baseline data (2017-2018) from previously hospitalised older patients (65-90 years), assessing all-cause mortality two years after discharge. We used logistic regression to assess the primary outcome, all-cause mortality two years after baseline hospitalisation. The primary predictors were cognitive function measured by The Mini Mental State Examination (MMSE) and prolonged CNSD use (continuous use ≥ 4 weeks). Adjustment variables: age, gender, education, the Hospital Anxiety and Depression Scale (HADS) and the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), using receiver operating characteristics (ROC) to compare the predictive power of the models. In a sub-analysis we used, the Neurobehavioural Cognitive State Examination (Cognistat) and the Clock Drawing Test.

RESULTS

Two years after discharge, out of 246 baseline patients, 43 were deceased at follow-up, among these 27 (63%) were CNSD users, and 16 (36%) were non-users at baseline, (p = 0.002). In the multivariable models cognitive function (MMSE score) was a predictor of mortality (OR 0.81 (95% CI 0.69; 0.96), p = 0.014). CNSD use was associated with mortality (OR 2.71 (95% CI 1.06; 6.95), p = 0.038), with ROC AUC: 0.74-0.77 for these models. Results using Cognistat supported the findings. The Clock Drawing Test was not significant predictor of mortality.

CONCLUSION

Two years after discharge from the hospital, older patients with reduced cognitive function and CNSD use during hospital stay had higher mortality. This underlines that inappropriate (prolonged and concurrent) use of CNSDs should be avoided by older patients, particularly in patients with reduced cognitive function.

TRIAL REGISTRATION

NCT03162081, 22 May 2017.

摘要

背景

老年患者经常长期使用中枢神经系统抑制剂（CNSD）（Z类催眠药、苯二氮䓬类药物和阿片类药物），这可能与认知能力下降有关。CNSD使用的长期影响以及老年患者认知功能下降的情况尚不清楚。本研究的目的是检验基线住院时的认知功能和CNSD使用情况是否与出院两年后的全因死亡率相关。

方法

我们进行了一项前瞻性观察性研究，纳入了之前住院的老年患者（65 - 90岁）的基线数据（2017 - 2018年），评估出院两年后的全因死亡率。我们使用逻辑回归来评估主要结局，即基线住院两年后的全因死亡率。主要预测因素是通过简易精神状态检查表（MMSE）测量的认知功能以及长期使用CNSD（连续使用≥4周）。调整变量：年龄、性别、教育程度、医院焦虑抑郁量表（HADS）和老年累积疾病评定量表（CIRS - G），使用受试者工作特征曲线（ROC）来比较模型的预测能力。在一项亚分析中，我们使用了神经行为认知状态检查（Cognistat）和画钟试验。

结果

出院两年后，在246名基线患者中，43名在随访时死亡，其中27名（63%）在基线时是CNSD使用者，16名（36%）在基线时是非使用者，（p = 0.002）。在多变量模型中，认知功能（MMSE评分）是死亡率的一个预测因素（比值比0.81（95%可信区间0.69；0.96），p = 0.014）。CNSD使用与死亡率相关（比值比2.71（95%可信区间1.06；6.95），p = 0.038），这些模型的ROC曲线下面积（AUC）为0.74 - 0.77。使用Cognistat的结果支持了这些发现。画钟试验不是死亡率的显著预测因素。