Braden score can independently predict 90-day mortality in critically ill patients with dementia

IF 3.6 3区医学 Q2 GERIATRICS & GERONTOLOGY

International Journal of Geriatric Psychiatry Pub Date : 2024-05-16 DOI:10.1002/gps.6093

Hongtao Cheng, Xinya Li, Xin Liang, Yonglan Tang, Fangxin Wei, Zichen Wang, Jun Lyu, Yu Wang

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引用次数: 0

Abstract

Background

Dementia is a significant cause of death in the older population and is becoming an important public health issue as the population ages and the prevalence of dementia increases. The Braden score is one of the most commonly used clinical tools to assess the risk of skin pressure injury in patients, and some studies have reported that it may reflect the state of frailty of patients. The present study attempted to explore the association between Braden score and 90-day mortality, pressure injury, and aspiration pneumonia in older patients with dementia in the intensive care unit (ICU).

Methods

The study involved extracting crucial data from the Medical Information Market for Intensive Care IV (MIMIC-IV) database using Structured Query Language, with a license certificate obtained after completing the necessary training and examination available on the MIMIC-IV website. A retrospective analysis was performed on older patients with dementia, aged 65 or older, who were first admitted to the ICU. Ninth and tenth revision International Classification of Diseases codes were used to identify patients with dementia. The primary outcome was 90-day mortality. Cox proportional hazards models were used to determine the association between Braden score and death, and hazard ratios (HR) and 95% confidence intervals (CI) were calculated. Propensity score matching and E-value assessments were employed for sensitivity analysis.

Results

A total of 2892 patients with a median age of approximately 85 years (interquartile range 78.74–89.59) were included, of whom 1625 were female (56.2%). Patients had a median Braden score of 14 (interquartile range 12–15) at ICU admission. Braden score at ICU admission was inversely associated with 90-day mortality risk after adjustment for demographics, severity of illness, treatment and medications, delirium, and sepsis (adjusted HR: 0.92, 95% CI: 0.87–0.98, p = 0.006). Patients were divided into two groups with a cut-off value of 15: high-risk group and low-risk group. Compared to the low-risk group (Braden score >15), the risk of 90-day mortality was significantly increased in the high-risk group (Braden score ≤15) (adjusted HR: 1.52, 95% CI: 1.10–2.09, p = 0.011, E-value: 2.01), the risk of pressure injury (adjusted OR: 2.62, 95% CI: 2.02–3.43, E-value: 2.62) and aspiration pneumonia (adjusted OR: 2.55, 95% CI: 1.84–3.61, E-value: 2.57) was also significantly higher.

Conclusions

The Braden score may be a quick and simple screening tool to identify the risk of adverse outcomes in critically ill older adults with dementia.

查看原文本刊更多论文

布莱登评分可独立预测患有痴呆症的重症患者的 90 天死亡率。

背景：痴呆症是导致老年人死亡的一个重要原因，随着人口老龄化和痴呆症患病率的增加，痴呆症正成为一个重要的公共卫生问题。布莱登评分是评估患者皮肤压力损伤风险最常用的临床工具之一，一些研究报告称它可能反映了患者的虚弱状态。本研究试图探讨重症监护室（ICU）中老年痴呆症患者的布莱登评分与 90 天死亡率、压伤和吸入性肺炎之间的关系：研究使用结构化查询语言（Structured Query Language）从重症监护医学信息市场IV（MIMIC-IV）数据库中提取关键数据，并在完成必要的培训和考试后获得许可证书，许可证书可在MIMIC-IV网站上查阅。我们对首次入住重症监护室的 65 岁或以上老年痴呆症患者进行了回顾性分析。采用第九版和第十版国际疾病分类代码来识别痴呆症患者。主要结果是 90 天死亡率。采用 Cox 比例危险模型确定布莱登评分与死亡之间的关系，并计算出危险比 (HR) 和 95% 置信区间 (CI)。在敏感性分析中采用了倾向评分匹配和E值评估：共纳入 2892 名患者，中位年龄约为 85 岁（四分位间范围为 78.74-89.59），其中 1625 人为女性（56.2%）。患者入住重症监护室时的布莱登评分中位数为 14（四分位间范围为 12-15）。在对人口统计学、病情严重程度、治疗和用药、谵妄和脓毒症等因素进行调整后，ICU 入院时的 Braden 评分与 90 天死亡风险成反比（调整后 HR：0.92，95% CI：0.87-0.98，p = 0.006）。以 15 为临界值将患者分为两组：高风险组和低风险组。与低风险组（Braden 评分 >15）相比，高风险组（Braden 评分≤15）的 90 天死亡风险显著增加（调整后 HR：1.52，95% CI：1.10-2.09，P = 0.011，E 值：2.01），压力性损伤（调整后 OR：2.62，95% CI：2.02-3.43，E 值：2.62）和吸入性肺炎（调整后 OR：2.55，95% CI：1.84-3.61，E 值：2.57）的风险也显著升高：布莱登评分可能是一种快速、简单的筛查工具，可用于识别患有痴呆症的重症老年人出现不良后果的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Geriatric Psychiatry 医学-精神病学

CiteScore

6.10

自引率

2.50%

发文量

168

审稿时长

4-8 weeks

期刊介绍： The rapidly increasing world population of aged people has led to a growing need to focus attention on the problems of mental disorder in late life. The aim of the Journal is to communicate the results of original research in the causes, treatment and care of all forms of mental disorder which affect the elderly. The Journal is of interest to psychiatrists, psychologists, social scientists, nurses and others engaged in therapeutic professions, together with general neurobiological researchers. The Journal provides an international perspective on the important issue of geriatric psychiatry, and contributions are published from countries throughout the world. Topics covered include epidemiology of mental disorders in old age, clinical aetiological research, post-mortem pathological and neurochemical studies, treatment trials and evaluation of geriatric psychiatry services.