在城市急症护理的老年人中虚弱、疾病严重程度和长期死亡率之间的关系。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association Pub Date : 2025-06-25 DOI:10.1016/j.jamda.2025.105718

Leonor Roa Santervas MD , Torgeir Bruun Wyller MD, PhD , Eva Skovlund MSc, PhD , Espen Saxhaug Kristoffersen MD, PhD , Rita Romskaug MD, PhD

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引用次数: 0

摘要

目的：死亡率的重要危险因素包括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，但年龄和虚弱对NEWS2和死亡率之间关系的影响尚不清楚，特别是在非医院环境中。本研究旨在探讨奥斯陆市急症住院（MipAC）住院的老年人虚弱、NEWS2和出院后1年死亡率之间的关系。设计：前瞻性观察研究。环境和参与者：入住MipAC单元的患者，随访1年的全因死亡率。方法：采用临床虚弱量表（CFS）评估患者的虚弱程度。入院时最大登记的NEWS2从患者记录中获得。使用Cox模型和Kaplan-Meier生存分析分析与1年死亡率的关系。结果：382例患者(平均年龄84.3岁；72%为女性)，1年随访期间死亡58例。在年龄校正Cox比例风险模型中，CFS和NEWS2与1年死亡率独立相关。校正后的风险比为：CFS每单位增加1.33 (95% CI, 1.07-1.66)， NEWS2每单位增加1.26 （95% CI, 1.14-1.39）。对导致NEWS2的生命体征的补充分析显示，呼吸频率升高和低血压与1年死亡率增加独立相关，调整后的危险比分别为2.71 （95% CI, 1.35-5.46）和3.05 （95% CI, 1.54-6.01）。当CFS和NEWS2联合使用时，低NEWS2（0-4）的中度至重度虚弱患者（CFS≥6）有死亡率增加的趋势，而高NEWS2（≥5）的患者，虚弱似乎没有进一步影响死亡风险。结论和意义：CFS、NEWS2和生命体征、呼吸频率升高和低血压与入住MipAC病房的患者1年死亡率相关。

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Associations Between Frailty, Illness Severity, and Long-Term Mortality Among Older Adults Admitted to Municipal Acute Care

Objectives

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.

Design

Prospective observational study.

Setting and Participants

Patients admitted to the MipAC unit with 1-year follow-up for all-cause mortality.

Methods

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.

Results

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.

Conclusions and Implications

CFS, NEWS2, and the vital signs elevated respiratory rate and hypotension are associated with 1-year mortality in patients admitted to a MipAC unit.

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来源期刊

Journal of the American Medical Directors Association 医学-老年医学

CiteScore

11.10

自引率

6.60%

发文量

472

审稿时长

44 days

期刊介绍： JAMDA, the official journal of AMDA - The Society for Post-Acute and Long-Term Care Medicine, is a leading peer-reviewed publication that offers practical information and research geared towards healthcare professionals in the post-acute and long-term care fields. It is also a valuable resource for policy-makers, organizational leaders, educators, and advocates. The journal provides essential information for various healthcare professionals such as medical directors, attending physicians, nurses, consultant pharmacists, geriatric psychiatrists, nurse practitioners, physician assistants, physical and occupational therapists, social workers, and others involved in providing, overseeing, and promoting quality