Department of Clinical Pharmacology, Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia; Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.
SA Pharmacy, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia.
J Am Med Dir Assoc. 2024 Aug;25(8):105083. doi: 10.1016/j.jamda.2024.105083. Epub 2024 Jun 13.
Hospital-acquired adverse drug reactions (HA-ADRs) are common in older adults. However, there is limited knowledge regarding the association between HA-ADRs and adverse clinical outcomes.
To investigate the incidence and characteristics of HA-ADRs in older adults, and any association with mortality, length of stay, and readmissions.
Prospective cohort study.
Flinders Medical Centre, a large tertiary referral hospital in Adelaide, South Australia. Older adults admitted under the General Medicine and Acute Care of the Elderly units with no previous diagnosis of dementia.
All patients had a Multidimensional Prognostic Index (MPI) assessment performed within 3 days of the admission. Data collected included age, gender, estimated glomerular filtration rate (eGFR), length of stay, readmissions, and mortality. HA-ADRs were identified by review of individual discharge summaries. Univariate and multivariate analyses were performed to investigate associations with clinical outcomes including mortality, length of stay, and readmissions. Exploratory analyses were performed for HA-ADR groups based on Medical Dictionary for Regulatory Activities System Organ Class and World Health Organization Anatomical Therapeutic Chemical classifications that accounted for ≥10% of all HA-ADRs.
There were 737 patients in the cohort with 72 having experienced a HA-ADRs (incidence = 9.8%). Patients with an HA-ADR had increased length of stay and 30-day readmissions compared with those without an HA-ADR. In multivariate analysis, the number of HA-ADRs was associated with in-hospital mortality and length of stay but not post-discharge mortality or readmissions within 30 days. In exploratory analyses, patients with an HA-ADR to antibacterial drugs had significantly higher rates of in-hospital mortality compared with those without these reactions.
The number of HA-ADRs are associated with in-hospital mortality and length of stay in older Australian inpatients. The occurrence of HA-ADRs may be a trigger to offer advice to prescribers to prevent future ADRs to similar agents and proactively manage disease to improve health outcomes.
医院获得性药物不良反应（HA-ADRs）在老年人中很常见。然而，关于 HA-ADRs 与不良临床结局之间的关联，我们知之甚少。
调查老年人中 HA-ADRs 的发生率和特征，以及其与死亡率、住院时间和再入院之间的任何关联。
前瞻性队列研究。
弗林德斯医疗中心，位于南澳大利亚州阿德莱德的一家大型三级转诊医院。入住普通内科和老年急性护理病房的老年人，且入院前无痴呆症诊断。
所有患者在入院后 3 天内进行多维预后指数（MPI）评估。收集的数据包括年龄、性别、估算肾小球滤过率（eGFR）、住院时间、再入院和死亡率。通过审查个人出院小结来确定 HA-ADRs。进行单变量和多变量分析，以调查与临床结局（包括死亡率、住院时间和再入院）相关的因素。基于占所有 HA-ADRs 比例≥10%的医疗字典监管活动系统器官分类和世界卫生组织解剖治疗化学分类，对 HA-ADR 组进行了探索性分析。
队列中有 737 名患者，其中 72 名发生 HA-ADRs（发生率为 9.8%）。与未发生 HA-ADR 的患者相比，发生 HA-ADR 的患者住院时间延长，30 天内再入院率更高。多变量分析显示，HA-ADR 的数量与院内死亡率和住院时间相关，但与出院后死亡率或 30 天内再入院无关。在探索性分析中，使用抗菌药物发生 HA-ADR 的患者院内死亡率明显高于未发生这些反应的患者。
HA-ADRs 的数量与澳大利亚老年住院患者的院内死亡率和住院时间相关。HA-ADRs 的发生可能是提示医生提供建议，以防止类似药物的未来 ADR，并积极治疗疾病，以改善健康结局。
