Solakoglu Gorkem Alper, Nuhoğlu Çağatay, Al Behcet, Adak Nur Aleyna, Arslan Banu
Department of Emergency Medicine, Istanbul Medeniyet University, Istanbul, Turkey.
Department of Emergency Medicine, Şişli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey.
BMC Geriatr. 2025 May 30;25(1):391. doi: 10.1186/s12877-025-06047-9.
The number of nonagenarians presenting to emergency departments (EDs) worldwide is rapidly increasing. These demographic faces unique challenges, including atypical clinical presentations, frailty, and a high burden of comorbidities. Despite their vulnerability, limited data exist on factors influencing survival in this group. This study aimed to identify prognostic factors affecting survival among nonagenarian patients admitted to the ED, focusing on clinical, biochemical, and treatment variables.
A retrospective review was conducted, analyzing data on demographics, comorbidities, medication use, laboratory values, and hospital stay length for nonagenarian patients admitted to the ED at Göztepe Prof. Dr. Süleyman Yalçın City Hospital from 2020 to 2023. Survival analysis utilized Kaplan-Meier and Cox regression methods, with statistical significance set at p < 0.05.
Among 316 patients (mean age 91.61 ± 1.76 years; 72.2% female), the mortality rate was 17.7%. The most frequent comorbidities were hypertension (76.8%) and heart failure (35.9%). Cardiac failure and treatment with beta-blockers were strong independent predictors of poor survival. Biochemical markers linked to increased mortality included low albumin (HR 0.353, p < 0.001), low total protein (HR 0.933, p = 0.004), elevated CRP/albumin ratio (HR 1.016, p = 0.001), and high neutrophil/albumin ratio (HR 1.002, p = 0.014).
Nonagenarians admitted to the ED exhibit high comorbidity prevalence and mortality rates. Inflammation and malnutrition biomarkers, particularly the CRP/albumin ratio and total protein, are significant prognostic factors. Tailored management strategies focusing on these parameters could improve outcomes for this high-risk group. Further multicenter studies are needed to validate these findings and develop evidence-based care protocols.
全球范围内前往急诊科就诊的九旬老人数量正在迅速增加。这些人群面临着独特的挑战，包括非典型临床表现、身体虚弱以及高合并症负担。尽管他们较为脆弱，但关于影响该群体生存的因素的数据有限。本研究旨在确定影响急诊科收治的九旬老人生存的预后因素，重点关注临床、生化和治疗变量。
进行了一项回顾性研究，分析了2020年至2023年在戈兹特佩苏莱曼·亚尔钦教授市立医院急诊科收治的九旬老人的人口统计学、合并症、用药情况、实验室检查值和住院时间数据。生存分析采用Kaplan-Meier法和Cox回归方法，设定统计学显著性为p < 0.05。
在316例患者中（平均年龄91.61 ± 1.76岁；72.2%为女性），死亡率为17.7%。最常见的合并症是高血压（76.8%）和心力衰竭（35.9%）。心力衰竭和使用β受体阻滞剂治疗是生存不良的强有力独立预测因素。与死亡率增加相关的生化标志物包括低白蛋白（HR 0.353，p < 0.001）、低总蛋白（HR 0.933，p = 0.004）、升高的CRP/白蛋白比值（HR 1.016，p = 0.001）和高中性粒细胞/白蛋白比值（HR 1.002，p = 0.014）。
急诊科收治的九旬老人合并症患病率和死亡率较高。炎症和营养不良生物标志物，特别是CRP/白蛋白比值和总蛋白，是重要的预后因素。针对这些参数的定制化管理策略可能改善这一高危群体的结局。需要进一步的多中心研究来验证这些发现并制定基于证据的护理方案。
