Dr. Filippo Luca Fimognari, Unit of Geriatrics, Ospedale dell'Annunziata, Via Felice Migliori, 87100 Cosenza. Tel: 0984-681346; fax: 0984-681521; e-mail:
J Frailty Aging. 2024;13(4):480-486. doi: 10.14283/jfa.2024.12.
Prevalence, correlates and outcomes of respiratory failure (RF) were never studied in large populations of older patients hospitalized in acute care medical settings. Little is known about the possible association between RF and delirium, and whether these two syndromes, alone or in combination, may affect short-term mortality.
To investigate prevalence and features of RF, the association between delirium and RF, and their effect on short-term mortality.
Prospective cross-sectional study with data collection on an index day and 30-day follow up.
1493 patients aged ≥ 65 years hospitalized in Italian acute medical wards from the 2017 Delirium Day database.
RF was identified according to the detection of peripheral oxygen saturation ≤ 91% on the index day, or to ongoing oxygen therapy or non-invasive ventilation on the index day or the day before. A modified National Early Warning Score (NEWS), obtained removing the "Oxygen Saturations" and "Any Supplemental Oxygen" items, measured non-hypoxemic severity of acute illness.
300 patients (20.1%) had RF. Mortality was 16.6% in the RF group and 8.2% in the non-RF group (p<0.001). Delirium prevalence was 31.3% in RF (94 patients, 72 of whom with hypoactive or mixed delirium) and 22% in non-RF patients (p<0.001). Age, frailty, modified NEWS, steroids use, presence of urinary catheters or other major devices, but not delirium, were independent RF correlates. RF alone (OR [odds ratio]: 1.83; 95% CI [confidence interval]: 1.02-3.29) predicted 30-day mortality after adjustment for confounders, including modified NEWS. Without adjustment for modified NEWS, the combination of delirium and RF also significantly predicted 30-day mortality (OR: 2.26; 95% CI 1.08-4.72).
In hospitalized older medical patients, RF was a prevalent syndrome which was frequently complicated by delirium. RF was featured by older age, frailty and severe illness, and independently predicted short-term mortality.
在急性医疗环境中住院的老年患者的大人群中，从未对呼吸衰竭（RF）的患病率、相关因素和结局进行过研究。对于 RF 与谵妄之间的可能关联，以及这两种综合征单独或联合是否会影响短期死亡率，我们知之甚少。
调查 RF 的患病率和特征、谵妄与 RF 之间的关系以及它们对短期死亡率的影响。
前瞻性横断面研究，在索引日和 30 天随访时收集数据。
来自意大利急性内科病房的 1493 名年龄≥65 岁的患者，来自 2017 年谵妄日数据库。
根据索引日外周血氧饱和度≤91%的检测结果，或根据索引日或前一天持续的氧气治疗或无创通气来确定 RF。改良的早期预警评分（NEWS），通过去除“血氧饱和度”和“任何补充氧气”项目来测量急性疾病的非低氧严重程度。
300 名患者（20.1%）患有 RF。RF 组的死亡率为 16.6%，非 RF 组为 8.2%（p<0.001）。RF 组的谵妄患病率为 31.3%（94 例，其中 72 例为低反应性或混合性谵妄），而非 RF 组为 22%（p<0.001）。年龄、虚弱、改良 NEWS、类固醇使用、导尿管或其他主要器械的存在，但不是谵妄，是 RF 的独立相关因素。在调整混杂因素后，包括改良 NEWS，RF 单独（OR：1.83；95%CI：1.02-3.29）预测 30 天死亡率。在未调整改良 NEWS 的情况下，谵妄和 RF 的组合也显著预测 30 天死亡率（OR：2.26；95%CI 1.08-4.72）。
在住院的老年内科患者中，RF 是一种常见的综合征，常伴有谵妄。RF 的特点是年龄较大、虚弱和病情严重，并且独立预测短期死亡率。
