Charlson Index is associated with one-year mortality in emergency department patients with suspected infection
Charlson Index is associated with one-year mortality in emergency department patients with suspected infection
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DOI：
10.1197/j.aem.2005.11.084
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发表时间：
2006-05-01
影响因子：
4.4
通讯作者：
Shapiro, NI
中科院分区：
文献类型：
--
作者：
Murray, SB;Bates, DW;Shapiro, NI
目标.患者的基线健康状况可能会影响急性疾病的生存能力。急诊医学研究需要工具来调整混杂因素，如共病。Charlson合并症指数已在许多环境中得到验证，但在急诊科（艾德）中并不广泛。本研究的目的是探讨效用的Charlson指数作为一个人口的艾德患者的一年死亡率的预测与疑似infection.Methods：共病的Charlson指数的组成部分，前瞻性地从成人（年龄大于18岁）艾德患者的医疗记录中提取感染的风险（表示的临床决定，以获得血培养）和加权。Charlson评分分为四个先前建立的指数：0分（无），1-2分（低），3-4分（中等），和！5分（高）。主要结果是使用国家死亡指数和医疗记录评估的一年死亡率。计算考克斯比例风险比，调整年龄，性别和标志物的28天住院mortals.Results：2000年2月1日至2001年2月1日，3,102独特的患者（96%的合格患者）在城市教学医院登记。总体一年死亡率为22%（667/3，102）。死亡率随Charlson评分增加而增加：无，7%（95%置信区间[CI] = 5.4%-8.5%）;低，22%（95% CI = 19%-24%）;中度，31%（95% CI = 27%-35%）;高，40%（95% CI = 36%-44%）。控制年龄、性别和与28天死亡率相关的因素，并以“无”组作为参照组，Charlson指数预测死亡率如下：低，优势比为2.0;中等，优势比为2.5;高，优势比为4.7。结论：本研究表明，Charlson指数预测疑似感染的艾德患者的1年死亡率。
Objectives. A patient's baseline health status may affect the ability to survive an acute illness. Emergency medicine research requires tools to adjust for confounders such as comorbid illnesses. The Charlson Comorbidity Index has been validated in many settings but not extensively in the emergency department (ED). The purpose of this study was to examine the utility of the Charlson Index as a predictor of one-year mortality in a population of ED patients with suspected infection.Methods: The comorbid illness components of the Charlson Index were prospectively abstracted from the medical records of adult (age older than 18 years) ED patients at risk for infection (indicated by the clinical decision to obtain a blood culture) and weighted. Charlson scores were grouped into four previously established indices: 0 points (none), 1-2 points (low), 3-4 points (moderate), and ! 5 points (high). The primary outcome was one-year mortality assessed using the National Death Index and medical records. Cox proportional-hazards ratios were calculated, adjusting for age, gender, and markers of 28-day in-hospital mortality.Results: Between February 1, 2000, and February 1, 2001, 3,102 unique patients (96% of eligible patients) were enrolled at an urban teaching hospital. Overall one-year mortality was 22%, (667/3,102). Mortality rates increased with increasing Charlson scores: none, 7% (95% confidence interval [CI] = 5.4%, to 8.5%); low, 22% (95% CI = 19% to 24%); moderate, 31% (95% CI = 27% to 35%); and high, 40% (95% CI = 36% to 44%). Controlling for age, gender, and factors associated with 28-day mortality, and using the "none" group as a reference group, the Charlson Index predicted mortality as follows: low, odds ratio of 2.0; moderate, odds ratio of 2.5; and high, odds ratio of 4.7.Conclusions: This study suggests that the Charlson Index predicts one-year mortality among ED patients with suspected infection.