Associations between Anticholinergic Burden and Adverse Health Outcomes in Parkinson Disease.
Associations between Anticholinergic Burden and Adverse Health Outcomes in Parkinson Disease.
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帕金森病抗胆碱能负担与不良健康结果之间的关联。
DOI：
10.1371/journal.pone.0150621
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Krewski D
中科院分区：
文献类型：
--
作者：
Crispo JA;Willis AW;Thibault DP;Fortin Y;Hays HD;McNair DS;Bjerre LM;Kohen DE;Perez-Lloret S;Mattison DR;Krewski D
老年人应避免使用具有抗胆碱能作用的药物，因为它们可能会增加不良事件的风险，包括福尔斯、谵妄和认知障碍。然而，关于抗胆碱能负荷的数据在亚群中是有限的，例如帕金森病（PD）患者。本研究的目的是确定抗胆碱能药物负荷是否与PD住院人群的不良结局相关。使用Cerner Health Facts®数据库，我们回顾性地检查了2000年至2011年期间在Cerner医院住院的16，302名PD住院患者的抗胆碱能药物使用，诊断和医院复诊。使用抗胆碱能风险量表（ARS）计算抗胆碱能负荷。主要结果是ARS评分与骨折和谵妄诊断之间的相关性。次要结局包括ARS评分与30天医院复查之间的相关性。许多个体（57.8%）处方了具有中度至极强抗胆碱能潜力的非PD药物。与无抗胆碱能药物负荷的患者相比，ARS评分最高（≥4）的患者更有可能被诊断为骨折（校正比值比（AOR）：1.56，95% CI：1.29-1.88）和谵妄（AOR：1.61，95% CI：1.08-2.40）。同样，ARS评分最高的住院患者更有可能在出院后30天内前往急诊室（校正风险比（AHR）：1.32，95% CI：1.10-1.58）和再次入院（AHR：1.16，95% CI：1.01-1.33）。我们发现PD患者抗胆碱能负荷增加与不良结局呈正相关。需要进行额外的药物警戒研究，以更好地了解PD患者使用抗胆碱能药物的相关风险。
Elderly adults should avoid medications with anticholinergic effects since they may increase the risk of adverse events, including falls, delirium, and cognitive impairment. However, data on anticholinergic burden are limited in subpopulations, such as individuals with Parkinson disease (PD). The objective of this study was to determine whether anticholinergic burden was associated with adverse outcomes in a PD inpatient population. Using the Cerner Health Facts® database, we retrospectively examined anticholinergic medication use, diagnoses, and hospital revisits within a cohort of 16,302 PD inpatients admitted to a Cerner hospital between 2000 and 2011. Anticholinergic burden was computed using the Anticholinergic Risk Scale (ARS). Primary outcomes were associations between ARS score and diagnosis of fracture and delirium. Secondary outcomes included associations between ARS score and 30-day hospital revisits. Many individuals (57.8%) were prescribed non-PD medications with moderate to very strong anticholinergic potential. Individuals with the greatest ARS score (≥4) were more likely to be diagnosed with fractures (adjusted odds ratio (AOR): 1.56, 95% CI: 1.29–1.88) and delirium (AOR: 1.61, 95% CI: 1.08–2.40) relative to those with no anticholinergic burden. Similarly, inpatients with the greatest ARS score were more likely to visit the emergency department (adjusted hazard ratio (AHR): 1.32, 95% CI: 1.10–1.58) and be readmitted (AHR: 1.16, 95% CI: 1.01–1.33) within 30-days of discharge. We found a positive association between increased anticholinergic burden and adverse outcomes among individuals with PD. Additional pharmacovigilance studies are needed to better understand risks associated with anticholinergic medication use in PD.