Carlos Mario Cortes Bahamon, Jenny Rodríguez Ángel, Jennifer Katherine Ballesteros Tapias, Diego Andrés Chavarro-Carvajal, Oscar Mauricio Muñoz
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引用次数: 0
Abstract
Introduction: The demographic transition has significantly increased the number of hospitalizations in octogenarian patients. Previous studies have documented the importance of clinical, functional, and cognitive variables for in-hospital mortality risk, but their frequency and importance in Latin American populations is yet to be described. It is important because Colombia has multiple ethnic races, with different types of longevity, and we have a history of social violence that affects our life expectancy. The aim of this study is to define which risk factors are associated with in-hospital mortality in octogenarians, and how frequent they are and quantify the weight of each of these factors in the outcomes.
Methodology: We present an analytical observational retrospective cohort study in adult patients over 80 years of age hospitalized and followed by the geriatrics service at Hospital Universitario San Ignacio (Bogotá, Colombia). The association between in-hospital mortality and multiple clinical, functional, and cognitive variables was evaluated by means of univariate and multivariate logistic regression analysis.
Results: A total of 1235 hospitalizations were analyzed (age 85.5 ± 4.4 years, 58.62% women). Malnutrition was documented in 22.4%, dependency for basic activities (Barthel ⩽ 95) in 75.9%, and positive screening for frailty (FRAIL ⩾ 3) in 55.3%. Mortality was 5.67%. Factors independently associated with mortality were history of cancer (Odds ratio (OR): 2.31; 95% Confidence interval (CI): 1.34-3.98, p < 0.003), delirium (OR: 2.48; 95% CI: 1.44-4.28, p < 0.001), malnutrition (OR: 2.50; 95% CI: 1.46-4.28; p = 0.001), frailty (OR: 2.25; 95% CI: 1.13-4.45, p = 0.019), tachypnea on admission (OR: 1.09; 95% CI: 1.03-1.14, p = 0.002), and creatinine elevation (OR: 2.47; 95% CI: 1.47-4.15, p = 0.001).
Conclusion: Factors easily identifiable at hospital admission and amenable to intervention could predict an increased risk of mortality in octogenarian patients, such as the presence of malnutrition, frailty, and delirium. These findings facilitate the estimation of mortality risk and serve as a starting point to investigate the potential benefit of early interventions in this population.
引言:人口结构的转变显著增加了80多岁患者的住院人数。先前的研究已经证明了临床、功能和认知变量对院内死亡风险的重要性,但它们在拉丁美洲人群中的频率和重要性尚未得到描述。这很重要,因为哥伦比亚有多个种族,长寿的方式各不相同,而且我们的社会暴力历史影响了我们的预期寿命。本研究的目的是确定哪些危险因素与80多岁老人的住院死亡率相关,以及它们的频率,并量化这些因素在结果中的权重。方法:我们提出了一项分析性观察性回顾性队列研究,研究对象是80岁以上住院的成年患者,随后是哥伦比亚波哥大圣伊格纳西奥大学医院的老年科服务。通过单因素和多因素logistic回归分析,评估住院死亡率与多种临床、功能和认知变量之间的关系。结果:共分析1235例住院病例(年龄85.5±4.4岁,女性58.62%)。营养不良的记录占22.4%,基本活动依赖(Barthel≥95)的记录占75.9%,虚弱筛查(虚弱的小于或小于3)的记录占55.3%。死亡率5.67%。与死亡率独立相关的因素是癌症史(优势比(OR): 2.31;95%置信区间(CI): 1.34-3.98, p p p = 0.001),虚弱(OR: 2.25;95% CI: 1.13-4.45, p = 0.019),入院时呼吸急促(OR: 1.09;95% CI: 1.03-1.14, p = 0.002),肌酐升高(OR: 2.47;95% CI: 1.47-4.15, p = 0.001)。结论:入院时容易识别且易于干预的因素可以预测八十多岁患者死亡风险的增加,如营养不良、虚弱和谵妄。这些发现有助于估计死亡风险,并可作为调查这一人群早期干预的潜在益处的起点。