Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Clinical Trials Unit, University of Bern, Bern, Switzerland.
PLoS One. 2023 Aug 9;18(8):e0288842. doi: 10.1371/journal.pone.0288842. eCollection 2023.
This prospective, observational study included adult patients from four mid-sized hospital general internal medicine units. During index hospitalization, we retrieved patient characteristics, including demographic and socioeconomic indicators, diagnoses, and early simplified HOSPITAL scores from electronic health records and patient interviews. Data on healthcare system use was collected using telephone interviews 30 days after discharge. Survival status at one year was collected by telephone and from health records. We used a univariable analysis including variables available from the hospitalization and 30-day post-discharge periods. We then performed multivariable analyses with one model using index hospitalization data and one using 30-day post-discharge data.
Of 934 patients, 123 (13.2%; 95% CI 11.0-15.4%) were readmitted or died within 30 days. Of 814 patients whose primary outcome was available, 108 died (13.3%) within one year. Using factors obtained during hospitalization, the early simplified HOSPITAL score (OR 1.50; 95% CI 1.31-1.71; P < 0.001) and not living at home (OR 4.0; 95% CI 1.8-8.3; P < 0.001) were predictors of one-year mortality. Using 30-day post-discharge predictors, hospital readmission was significantly associated with one-year mortality (OR 4.81; 95% CI 2.77-8.33; P < 0.001).
Factors predicting one-year mortality were a high early simplified HOSPITAL score, not living at home, and a 30-day unplanned readmission.
1）利用住院期间的可用因素，确定住院内科患者一年内死亡的预测因素。2）评估出院后 30 天内的医疗保健系统使用情况是否与一年内的死亡率相关。
本前瞻性观察性研究纳入了来自四个中等规模医院综合内科病房的成年患者。在住院期间，我们从电子病历和患者访谈中检索了患者特征，包括人口统计学和社会经济学指标、诊断和早期简化 HOSPITAL 评分。出院后 30 天通过电话收集了医疗保健系统使用情况的数据。通过电话和健康记录收集了一年后的生存状况。我们使用单变量分析包括住院期间和出院后 30 天期间可用的变量。然后，我们使用一个模型使用住院期间的数据，另一个模型使用出院后 30 天的数据进行多变量分析。
在 934 名患者中，有 123 名（13.2%；95%置信区间 11.0-15.4%）在 30 天内再次入院或死亡。在 814 名主要结局可用的患者中，有 108 人（13.3%）在一年内死亡。使用住院期间获得的因素，早期简化 HOSPITAL 评分（OR 1.50；95%置信区间 1.31-1.71；P<0.001）和不住在家里（OR 4.0；95%置信区间 1.8-8.3；P<0.001）是一年内死亡的预测因素。使用出院后 30 天的预测因素，医院再入院与一年内的死亡率显著相关（OR 4.81；95%置信区间 2.77-8.33；P<0.001）。
预测一年内死亡率的因素是早期简化 HOSPITAL 评分高、不住在家里和 30 天内无计划再入院。
