日常生活活动受限和住院期间功能下降预测老年肺炎患者 180 天再入院和死亡率：一项单中心回顾性队列研究。

Activities of daily living limitation and functional decline during hospitalization predict 180-day readmission and mortality in older patients with pneumonia: A single-center, retrospective cohort study.

机构信息

Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan; Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan.

出版信息

Respir Med. 2024 Nov-Dec;234:107830. doi: 10.1016/j.rmed.2024.107830. Epub 2024 Oct 4.

DOI:10.1016/j.rmed.2024.107830

PMID:39368559

Abstract

BACKGROUND

The role of activities of daily living (ADL) as a predictor of adverse outcomes in patients with pneumonia is unclear. This study aimed to assess the association between ADL, including physical and cognitive function, and death or readmission in older inpatients with pneumonia.

METHODS

This retrospective, single-center, observational study included consecutive older inpatients with pneumonia between October 2018 and December 2019. ADL was assessed using the Functional Independence Measure (FIM). Functional decline during hospitalization was defined as a decrease of at least 1 point in FIM at discharge from admission. The primary outcome was the time to composite 180-day mortality and readmission from any cause after discharge.

RESULTS

In total, 363 patients (median [interquartile range] age: 80 [73-86] years, male: 68 %) were divided according to the median FIM scores (≥100, n = 183 and < 100, n = 180). Among the patients, 25 experienced functional decline during hospitalization, 69 were readmitted, and 17 died. In the Kaplan-Meier analysis, both the lower FIM group and the functional decline group had significantly lower event-free rates than the higher FIM groups and the non-functional decline groups (log-rank test, p < 0.001), respectively. After multivariate analysis, both the lower FIM (adjusted HR, 2.11; 95 % CI, 1.24-3.58; p = 0.006) and functional decline (adjusted HR, 3.18; 95 % CI, 1.44-7.05; p = 0.005) were significantly associated with the primary outcome.

CONCLUSIONS

In older patients hospitalized with pneumonia, ADL limitations at discharge and a decline in ADL were associated with poor outcomes.

摘要

背景

日常生活活动（ADL）作为肺炎患者不良结局的预测因素的作用尚不清楚。本研究旨在评估 ADL（包括身体和认知功能）与老年肺炎住院患者死亡或再入院之间的关系。

方法

这是一项回顾性、单中心、观察性研究，纳入了 2018 年 10 月至 2019 年 12 月间连续收治的老年肺炎住院患者。使用功能独立性测量量表（FIM）评估 ADL。住院期间功能下降定义为入院时 FIM 评分至少下降 1 分。主要结局是出院后 180 天复合死亡率和任何原因再入院的时间。

结果

共纳入 363 例患者（中位数[四分位间距]年龄：80[73-86]岁，男性：68%），根据 FIM 中位数评分（≥100，n=183 和＜100，n=180）进行分组。其中，25 例患者住院期间出现功能下降，69 例患者再入院，17 例患者死亡。在 Kaplan-Meier 分析中，FIM 评分较低组和功能下降组的无事件生存率明显低于 FIM 评分较高组和无功能下降组（对数秩检验，p＜0.001）。多变量分析后，FIM 评分较低（调整后的 HR，2.11；95%CI，1.24-3.58；p=0.006）和功能下降（调整后的 HR，3.18；95%CI，1.44-7.05；p=0.005）均与主要结局显著相关。