导尿管的存在是内科患者住院死亡率的一个重要预测因素。

The presence of a urinary catheter is an important predictor of in-hospital mortality in internal medicine patients.

机构信息

Department of Internal Medicine B, Laniado Hospital, Netanya, Israel.

Ruth and Bruce Rappaport School of Medicine, Technion University, Haifa, Israel.

出版信息

J Eval Clin Pract. 2022 Dec;28(6):1113-1118. doi: 10.1111/jep.13694. Epub 2022 May 5.

DOI:10.1111/jep.13694

PMID:35510815

Abstract

RATIONALE AND OBJECTIVE

Mortality rates are used to assess the quality of hospital care after appropriate adjustment for case-mix. Urinary catheters are frequent in hospitalized adults and might be a marker of patient frailty and illness severity. However, we know of no attempts to estimate the predictive value of indwelling catheters for specific patient outcomes. The objective of the present study was to (a) identify the variables associated with the presence of a urinary catheter and (b) determine whether it predicts in-hospital mortality after adjustment for these variables.

METHODS

The study population included all acutely admitted adult patients in 2020 (exploratory cohort) and January-October 2021 (validation cohort) to internal medicine, cardiology and intensive care departments at the Laniado Hospital, a regional hospital with 400 beds in Israel. There were no exclusion criteria. The predictor variables were the presence of a urinary catheter on admission, age, gender, comorbidities and admission laboratory test results. We used bivariate and multivariate logistic regression to test the associations between the presence of a urinary catheter and mortality after adjustment for the remaining independent variables on admission.

RESULTS

The presence of a urinary catheter was associated with other independent variables. In 2020, the odds of in-hospital mortality in patients with a urinary catheter before and after adjustment for the remaining predictors were 14.3 (11.6-17.7) and 6.05 (4.78-7.65), respectively. Adding the presence of a urinary catheter to the prediction logistic regression model increased its c-statistic from 0.887 (0.880-0.894) to 0.907 (0.901-0.913). The results of the validation cohort reduplicated those of the exploratory cohort.

CONCLUSIONS

The presence of a urinary catheter on admission is an important and independent predictor of in-hospital mortality in acutely hospitalized adults in internal medicine departments.

摘要

背景和目的

死亡率可用于评估经过病例组合适当调整后的医院护理质量。导尿管在住院成人中很常见，可能是患者虚弱和疾病严重程度的标志。然而，我们不知道是否有尝试估计留置导尿管对特定患者结局的预测价值。本研究的目的是：(a) 确定与导尿管存在相关的变量；(b) 确定在调整这些变量后，它是否可以预测住院内死亡率。

方法

研究人群包括 2020 年（探索性队列）和 2021 年 1 月至 10 月（验证性队列）急性入住兰尼埃多医院内科、心脏病科和重症监护病房的所有成年患者。无排除标准。预测变量为入院时导尿管的存在、年龄、性别、合并症和入院实验室检查结果。我们使用二变量和多变量逻辑回归来检验在调整入院时其余独立变量后，导尿管的存在与死亡率之间的关联。

结果

导尿管的存在与其他独立变量相关。2020 年，在调整其余预测因素前后，导尿管存在的患者住院内死亡的几率分别为 14.3（11.6-17.7）和 6.05（4.78-7.65）。将导尿管的存在添加到预测逻辑回归模型中，其 c 统计量从 0.887（0.880-0.894）增加到 0.907（0.901-0.913）。验证队列的结果复制了探索性队列的结果。