Roa Santervas Leonor, Wyller Torgeir Bruun, Skovlund Eva, Kristoffersen Espen Saxhaug, Romskaug Rita
Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway; City of Oslo Health Agency, Municipality of Oslo, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
J Am Med Dir Assoc. 2025 Aug;26(8):105718. doi: 10.1016/j.jamda.2025.105718. Epub 2025 Jun 25.
Important risk factors for mortality include frailty and illness severity. The National Early Warning Score 2 (NEWS2) is widely used to assess acute illness severity and mortality risk, but age and frailty's impact on the association between NEWS2 and mortality is less understood, particularly in nonhospital settings. This study aimed to examine the associations between frailty, NEWS2, and 1-year postdischarge mortality in older adults admitted to the Oslo Municipal In-Patient Acute Care (MipAC) unit.
Prospective observational study.
Patients admitted to the MipAC unit with 1-year follow-up for all-cause mortality.
Frailty was assessed using the Clinical Frailty Scale (CFS). The maximum registered NEWS2 during admission was obtained from patient records. Associations with 1-year mortality were analyzed using a Cox model and Kaplan-Meier survival analysis.
Among 382 patients (mean age, 84.3 years; 72% female), 58 died during the 1-year follow-up period. Both CFS and NEWS2 were independently associated with 1-year mortality in an age-adjusted Cox proportional hazards model. The adjusted hazard ratios were 1.33 (95% CI, 1.07-1.66) per unit increase in CFS and 1.26 (95% CI, 1.14-1.39) per unit increase in NEWS2. A supplementary analysis of the vital signs contributing to NEWS2 revealed that elevated respiratory rate and hypotension were independently associated with increased 1-year mortality, with adjusted hazards ratios being 2.71 (95% CI, 1.35-5.46) and 3.05 (95% CI, 1.54-6.01), respectively. When combining CFS and NEWS2, moderately to severely frail patients (CFS ≥6) with low NEWS2 (0-4) showed a tendency toward increased mortality, whereas among those with high NEWS2 (≥5), frailty did not appear to further influence mortality risk.
CFS, NEWS2, and the vital signs elevated respiratory rate and hypotension are associated with 1-year mortality in patients admitted to a MipAC unit.
死亡率的重要危险因素包括身体虚弱和疾病严重程度。国家早期预警评分2（NEWS2）被广泛用于评估急性疾病严重程度和死亡风险，但年龄和身体虚弱对NEWS2与死亡率之间关联的影响尚不清楚，尤其是在非医院环境中。本研究旨在探讨奥斯陆市住院急性护理（MipAC）病房收治的老年人中，身体虚弱、NEWS2与出院后1年死亡率之间的关联。
前瞻性观察性研究。
入住MipAC病房且随访1年全因死亡率的患者。
使用临床虚弱量表（CFS）评估身体虚弱程度。从患者记录中获取入院期间记录的最高NEWS2。使用Cox模型和Kaplan-Meier生存分析分析与1年死亡率的关联。
在382例患者（平均年龄84.3岁；72%为女性）中，58例在1年随访期内死亡。在年龄调整的Cox比例风险模型中，CFS和NEWS2均与1年死亡率独立相关。CFS每增加一个单位，调整后的风险比为1.33（95%CI, 1.07 - 1.66）；NEWS2每增加一个单位，调整后的风险比为1.26（95%CI, 1.14 - 1.39）。对构成NEWS2 的生命体征进行的补充分析显示，呼吸频率升高和低血压与1年死亡率增加独立相关，调整后的风险比分别为2.71（95%CI, 1.35 - 5.46）和3.05（95%CI, 1.54 - 6.01）。当将CFS和NEWS2结合起来时，NEWS2较低（0 - 4）的中度至重度虚弱患者（CFS≥6）显示出死亡率增加的趋势，而在NEWS2较高（≥5）的患者中，身体虚弱似乎并未进一步影响死亡风险。
CFS、NEWS2以及呼吸频率升高和低血压等生命体征与入住MipAC病房患者的1年死亡率相关。
