PRO-AGE工具及其与急诊科收治的老年患者出院后结局的关联。
The PRO-AGE Tool and Its Association With Post Discharge Outcomes in Older Adults Admitted From the Emergency Department.
作者信息
Cohen Inessa, Curiati Pedro K, Morinaga Christian V, Han Ling, Gandhi Tanish, Araujo Katy, Avelino-Silva Thiago J, Bianco Luann M, Brandt Cynthia A, Capelli Sandra, Carpenter Christopher R, Cruz Daniel S, Dresden Scott M, Fishman Ivy L, Gipson Katrina, Gray Elizabeth, Hastings S Nicole, Hung William W, Kang Raymond, Lockhart Mechelle, Meeker Daniella, Ohuabunwa Ugochi, Ottilie-Kovelman Sierra, Platts-Mills Timothy F, Sandoval Jacqueline, Sifnugel Natalia, Taylor Zachary, Tomasino Debra F, Vaughan Camille P, Aliberti Márlon J R, Hwang Ula
机构信息
Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
Department of Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, Connecticut, USA.
出版信息
J Am Geriatr Soc. 2025 May;73(5):1419-1428. doi: 10.1111/jgs.19374. Epub 2025 Jan 22.
BACKGROUND
Existing risk scores assessing geriatric vulnerability in the emergency department (ED) have shown limited predictive power, especially in diverse populations. We investigated the relationship of a quick and easy-to-administer geriatric vulnerability scoring system with functional decline and mortality in older patients admitted to multiple hospitals through the ED in the United States (US) and Brazil (BR).
METHOD
Federated, international, multicenter observational study of hospitalized ED patients aged ≥ 65 from US and BR. The six criteria from the PRO-AGE score (Physical impairment, Recent hospitalization, Older age [≥ 90], Acute mental alteration, Getting thinner, and Exhaustion; 0-8; higher scores = greater vulnerability) were assessed on admission. We used proportional hazards models to investigate the relationships between PRO-AGE score groups and 90-day mortality and functional decline, defined as new dependence in activities of daily living (ADL) and instrumental ADL (IADL), after adjusting for age, sex, race and ethnicity, education, Charlson comorbidity score, and study site. Death was considered a competing event for the functional decline outcome.
RESULTS
A total of 1390 patients were included (US = 560; Brazil = 830). The 90-day risk of death was higher for the upper compared with the lower (reference) PRO-AGE group in both cohorts (US: HR = 11.76; 95% confidence interval [CI] = 2.56-54.04; BR: HR = 12.29; 95% CI = 3.54-42.59), whereas the risk of new 90-day ADL disability was higher for upper (HR = 2.08; 95% CI = 1.21-3.56) and middle groups (HR = 2.10; 95% CI = 1.35-3.27) in the US but only the upper group in BR (HR = 1.70; 95% CI = 1.02-2.85).
CONCLUSION
A higher PRO-AGE score was associated with mortality and functional decline in older ED patients admitted to hospitals in the US and BR, demonstrating its generalizability as a geriatric vulnerability risk score.
背景
现有的评估急诊科老年患者脆弱性的风险评分显示出有限的预测能力，尤其是在不同人群中。我们调查了一种快速且易于实施的老年脆弱性评分系统与在美国（US）和巴西（BR）通过急诊科入院的老年患者功能衰退和死亡率之间的关系。
方法
对来自美国和巴西年龄≥65岁的住院急诊科患者进行联合、国际、多中心观察性研究。在入院时评估PRO-AGE评分的六个标准（身体损伤、近期住院、高龄[≥90岁]、急性精神改变、体重减轻和疲惫；0-8分；分数越高=脆弱性越大）。我们使用比例风险模型来研究在调整年龄、性别、种族和民族、教育程度、Charlson合并症评分和研究地点后，PRO-AGE评分组与90天死亡率和功能衰退之间的关系，功能衰退定义为日常生活活动（ADL）和工具性ADL（IADL）出现新的依赖。死亡被视为功能衰退结局的竞争事件。
结果
共纳入1390例患者（美国=560例；巴西=830例）。在两个队列中，与较低（参照）PRO-AGE组相比，较高PRO-AGE组的90天死亡风险更高（美国：风险比[HR]=11.76；95%置信区间[CI]=2.56-54.04；巴西：HR=12.29；95%CI=3.54-42.59），而在美国，较高PRO-AGE组（HR=2.08；95%CI=1.21-3.56）和中间组（HR=2.10；95%CI=1.35-3.27）出现新的90天ADL残疾的风险更高，但在巴西仅较高PRO-AGE组（HR=1.70；95%CI=1.02-2.85）。
结论
较高的PRO-AGE评分与在美国和巴西医院急诊科入院的老年患者的死亡率和功能衰退相关，表明其作为老年脆弱性风险评分具有可推广性。
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