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认知功能障碍是否会影响因 COVID-19 住院的老年患者的住院时间和住院死亡率?

Does cognitive function impairment affect the duration of hospitalization and in-hospital mortality in geriatric patients hospitalized for COVID-19?

机构信息

Department of Anesthesiology and Intensive Therapy, 4th Military Clinical Hospital, Wroclaw, Poland.

Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland.

出版信息

PLoS One. 2023 Apr 25;18(4):e0284977. doi: 10.1371/journal.pone.0284977. eCollection 2023.

Abstract

AIMS

To assess the effect of cognitive function, performance of activities of daily living (ADLs), degree of depression, and fear of infection among geriatric patients hospitalized in internal medicine wards for COVID-19 on the duration of hospitalization and in-hospital mortality.

METHODS

This observational survey study was conducted during the second, third, and fourth waves of the COVID-19 pandemic. The study included elderly patients of both sexes, aged ≥ 65 years, hospitalized for COVID-19 in internal medicine wards. The following survey tools were used: AMTS, FCV-19S, Lawton IADL, Katz ADL, and GDS15. The duration of hospitalization and in-hospital mortality were also assessed.

RESULTS

A total of 219 patients were included in the study. The results showed that impaired cognitive function in geriatric patients (AMTS) was associated with higher in-hospital mortality among COVID-19 patients. There was no statistical significance between fear of infection (FCV-19S) and risk of death. The impaired ability to perform complex ADLs (Lawton IADL) before the onset of the disease was not associated with higher in-hospital mortality among COVID-19 patients. The diminished ability to perform basic ADLs (Katz ADL) before the onset of the disease was not associated with higher in-hospital mortality in COVID-19. The degree of depression (GDS15) was not associated with higher in-hospital mortality in COVID-19 patients. Statistically, significantly better survival was observed for patients with normal cognitive function (p = 0.005). No statistically significant differences in survival were observed in relation to the degree of depression or independence in performing ADLs. Cox proportional hazards regression analysis showed a statistically significant effect of age on mortality (p = 0.004, HR 1.07).

CONCLUSION

In this study, we observe that cognitive function impairments and the older age of patients treated for COVID-19 in the medical ward increase the in-hospital risk of death.

摘要

目的

评估 COVID-19 内科住院老年患者的认知功能、日常生活活动(ADL)能力、抑郁程度和对感染的恐惧对住院时间和院内死亡率的影响。

方法

本观察性调查研究在 COVID-19 大流行的第二、三、四波期间进行。研究纳入了内科病房住院治疗 COVID-19 的男女老年患者,年龄≥65 岁。使用了以下调查工具:AMTS、FCV-19S、Lawton IADL、Katz ADL 和 GDS15。还评估了住院时间和院内死亡率。

结果

共纳入 219 例患者。结果表明,老年患者认知功能障碍(AMTS)与 COVID-19 患者住院死亡率较高有关。感染恐惧(FCV-19S)与死亡风险之间无统计学意义。发病前复杂 ADL 能力受损(Lawton IADL)与 COVID-19 患者住院死亡率升高无关。发病前基本 ADL 能力下降(Katz ADL)与 COVID-19 患者住院死亡率升高无关。抑郁程度(GDS15)与 COVID-19 患者住院死亡率升高无关。统计学上,认知功能正常的患者存活情况明显更好(p=0.005)。抑郁程度或 ADL 独立性与存活情况无统计学差异。Cox 比例风险回归分析显示,年龄对死亡率有统计学显著影响(p=0.004,HR 1.07)。

结论

在这项研究中,我们观察到内科病房中 COVID-19 治疗患者的认知功能障碍和年龄较大增加了院内死亡风险。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2443/10128959/4d92f7766345/pone.0284977.g001.jpg

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