Department of General Medicine, Sengkang General Hospital, Singapore.
Ann Acad Med Singap. 2022 Mar;51(3):161-169. doi: 10.47102/annals-acadmedsg.2021427.
This study aimed to identify risk factors that are associated with increased mortality that could prompt a serious illness conversation (SIC) among patients with chronic kidney disease (CKD).
The electronic health records of adult CKD patients admitted between August 2018 and February 2020 were retrospectively reviewed to identify CKD patients with >1 hospitalisation and length of hospital stay ≥4 days. Outcome measures were mortality and the duration of hospitalisation. We also assessed the utility of the Cohen's model to predict 6-month mortality among CKD patients.
A total of 442 patients (mean age 68.6 years) with median follow-up of 15.3 months were identified. The mean (standard deviation) Charlson Comorbidity Index [CCI] was 6.8±2.0 with 48.4% on chronic dialysis. The overall mortality rate until August 2020 was 36.7%. Mortality was associated with age (hazard ratio [HR] 1.51, 95% confidence interval [CI] 1.29-1.77), CCI≥7 (1.58, 1.08-2.30), lower serum albumin (1.09, 1.06-1.11), readmission within 30-day (1.96, 1.43-2.68) and CKD non-dialysis (1.52, 1.04-2.17). Subgroup analysis of the patients within first 6-month from index admission revealed longer hospitalisation stay for those who died (CKD-non dialysis: 5.5; CKD-dialysis: 8.0 versus 4 days for those survived, <0.001). The Cohen's model demonstrated reasonable predictive ability to discriminate 6-month mortality (area under the curve 0.81, 95% CI 0.75-0.87). Only 24 (5.4%) CKD patients completed advanced care planning.
CCI, serum albumin and recent hospital readmission could identify CKD patients at higher risk of mortality who could benefit from a serious illness conversation.
本研究旨在确定与死亡率增加相关的风险因素，这些因素可能促使慢性肾脏病（CKD）患者进行严重疾病对话（SIC）。
回顾性分析 2018 年 8 月至 2020 年 2 月期间住院的成年 CKD 患者的电子健康记录，以确定住院>1 次且住院时间≥4 天的 CKD 患者。结局指标为死亡率和住院时间。我们还评估了 Cohen 模型预测 CKD 患者 6 个月死亡率的效用。
共纳入 442 例患者（平均年龄 68.6 岁），中位随访时间为 15.3 个月。Charlson 合并症指数（CCI）的平均值（标准差）为 6.8±2.0，48.4%的患者正在接受慢性透析。截至 2020 年 8 月的总死亡率为 36.7%。死亡率与年龄（危险比 [HR] 1.51，95%置信区间 [CI] 1.29-1.77）、CCI≥7（1.58，1.08-2.30）、血清白蛋白较低（1.09，1.06-1.11）、30 天内再入院（1.96，1.43-2.68）和 CKD 非透析（1.52，1.04-2.17）相关。在索引入院后前 6 个月的患者亚组分析中，死亡患者的住院时间更长（CKD-非透析：5.5；CKD-透析：8.0 与存活患者的 4 天相比，<0.001）。Cohen 模型在区分 6 个月死亡率方面具有较好的预测能力（曲线下面积 0.81，95%CI 0.75-0.87）。仅有 24 例（5.4%）CKD 患者完成了高级医疗计划。
CCI、血清白蛋白和近期住院再入院可识别出死亡率较高的 CKD 患者，这些患者可能受益于严重疾病对话。
