Mao Mian, Du Shan, Xu Yue, Li Qiu, Luo Ruoxi, Zhou Qiaoqiao, Hu Xiaoli
Department of Pharmacy, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, People's Republic of China.
Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People's Republic of China.
Sci Rep. 2025 Jan 2;15(1):166. doi: 10.1038/s41598-024-84064-1.
Elderly patients with multiple concomitant chronic diseases are the particularly vulnerable during the Coronavirus disease 2019 (COVID-19) epidemic, which accounts for a large number of COVID-19-related deaths. The purpose of the study was to investigate the impact of polypharmacy and potentially inappropriate medications (PIMs) on in-hospital mortality in a secondary hospital in China. A cross-sectional, retrospective study was conducted using electronic medical data collected from Shanghai Gonghui Hospital from April 2022 to June 2022. Two types of PIMs were adopted, involving the evaluation of the PIM status of older patients with COVID-19 (age ≥ 60 years) identified by AGS/Beers Criteria (PIM-Beers) and the PIM related to Covid-19 antiviral NMV/r (Nirmatrelvir/ritonavir) (PIM-NMV/r). Multivariate logistic regression was used to identify the risk factors associated with PIM use and in-hospital mortality. A total of 617 older COVID-19 inpatients were included in the study. The prevalence of polypharmacy and excessive polypharmacy were 24.6% and 19.1%, respectively. The prevalence of PIMs, PIM-Beers, and PIM-NMV/r were 25.8%, 22.5%, and 60.8%, respectively. Multivariate regression demonstrated that male (OR: 0.57 [95% CI: 0.33-0.98], p = 0.044), diabetes (OR: 2.05 [95% CI: 1.11-3.80], p = 0.023), the more number of medications (OR: 1.44 [95% CI: 1.20-1.72], p < 0.001) and given NMV/r (OR: 3.67 [95% CI: 1.48-9.10], p = 0.005) were influencing factors associated with PIM use. A multivariate logistic regression demonstrated that severe COVID-19 (OR: 6.56 [95% CI: 1.13-38.03], p = 0.036), polypharmacy (OR: 15.43 [95% CI: 3.20-74.29], p = 0.001), excessive polypharmacy (OR: 51.09 [95% CI: 5.23-499.52], p = 0.001), and long-term hospitalization (OR: 0.08 [95% CI: 0.02-0.32], p < 0.001) were influencing factors associated with in-hospital mortality in older COVID-19 inpatients. The polypharmacy and drug-drug interactions of NMV/r were observed in many older COVID-19 inpatients. Older patients with severe COVID-19, a higher number of medications and long-term hospitalization had a higher in-hospital mortality. This result highlights the importance of conducting clinical pharmacists-led medication reviews to identify PIMs of NMV/r and collaboratively working with the physicians to ensure medication appropriateness.
患有多种慢性疾病的老年患者在2019冠状病毒病（COVID-19）疫情期间特别脆弱，这部分患者占COVID-19相关死亡病例的很大一部分。本研究的目的是调查在中国一家二级医院中，多重用药和潜在不适当用药（PIMs）对住院死亡率的影响。利用2022年4月至2022年6月期间从上海公惠医院收集的电子医疗数据进行了一项横断面回顾性研究。采用了两种类型的PIMs，包括根据AGS/Beers标准评估60岁及以上COVID-19老年患者的PIM状态（PIM-Beers）以及与COVID-19抗病毒药物NMV/r（奈玛特韦/利托那韦）相关的PIM（PIM-NMV/r）。采用多因素逻辑回归来确定与PIM使用和住院死亡率相关的危险因素。本研究共纳入617例COVID-19老年住院患者。多重用药和过度多重用药的患病率分别为24.6%和19.1%。PIMs、PIM-Beers和PIM-NMV/r的患病率分别为25.8%、22.5%和60.8%。多因素回归显示，男性（比值比：0.57 [95%置信区间：0.33 - 0.98]，p = 0.044）、糖尿病（比值比：2.05 [95%置信区间：1.11 - 3.80]，p = 0.023）、用药数量越多（比值比：1.44 [95%置信区间：1.20 - 1.72]，p < 0.001）以及使用NMV/r（比值比：3.67 [95%置信区间：1.48 - 9.10]，p = 0.005）是与PIM使用相关的影响因素。多因素逻辑回归显示，重症COVID-19（比值比：6.56 [95%置信区间：1.13 - 38.03]，p = 0.036）、多重用药（比值比：15.43 [95%置信区间：3.20 - 74.29]，p = 0.001）、过度多重用药（比值比：51.09 [95%置信区间：5.23 - 499.52]，p = 0.001）以及长期住院（比值比：0.08 [95%置信区间：0.02 - 0.32]，p <
