Elsevier Editorial System(tm) for Journal of the American Medical Directors Association Manuscript Draft Manuscript Number: JAMDA-D-14-00269R1 Title: Is this elderly patient dehydrated? Diagnostic accuracy of hydration assessment using physical signs, urine and saliva markers
Elsevier Editorial System(tm) for Journal of the American Medical Directors Association Manuscript Draft Manuscript Number: JAMDA-D-14-00269R1 Title: Is this elderly patient dehydrated? Diagnostic accuracy of hydration assessment using physical signs, urine and saliva markers
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爱思唯尔编辑系统(tm) 美国医学主任协会杂志手稿手稿编号：JAMDA-D-14-00269R1 标题：这位老年患者脱水吗？
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发表时间：
2014
期刊：
影响因子：
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通讯作者：
N. Walsh
中科院分区：
文献类型：
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作者：
N. Walsh;M. B. Fortes;J. Owen;Philippa Raymond;C. Bishop;Salah Elghenzai;S. Oliver;N. Walsh;N. Walsh
目的：老年人脱水导致住院期间发病率和死亡率增加。因此，脱水的早期诊断可以改善患者的结果并减轻医疗保健的负担。这项前瞻性研究调查了常规使用的体征7和尿液和唾液中水合作用的非侵入性标志物的诊断准确性。设计：前瞻性诊断准确性研究。地点：医院急症室和急诊科。参与者：139名老年人（59名男性，71名女性，平均（SD）年龄= 78（9）岁）。测量：具有任何10个主要诊断的参与者在入院后30分钟内进行水合评估。水合11评估包括脱水的七种体征（心动过速（> 100 bpm）、低收缩压（<100 mmHg）、粘膜干燥、腋窝干燥、皮肤肿胀差、眼睛凹陷和长毛细血管13再充盈时间（>2s））、尿液颜色、尿液比重（USG）、唾液流速（SFR）和唾液渗透压。14血浆渗透压（Posm）和血尿素氮与肌酐比值（BUN：Cr）被评估为15个水合参考标准，21%的参与者被归类为失水脱水（Posm 16 > 295 mOsm/kg），19%被归类为失水和溶质脱水（BUN：Cr >20），60%被归类为17个水合正常。结果如下：所有体征对检测任一脱水形式的敏感性均较低（0-44%），只有低收缩压显示出辅助诊断水和溶质丢失脱水的潜在效用（诊断OR = 14.7）。尿液颜色、USG和SFR均不能区分水化状态（受试者工作特征曲线下面积，AUCROC = 0.49-0.57，21 P>0.05）。相比之下，唾液渗透压显示中等诊断准确性（AUCROC = 0.76，22 P<0.001）区分两种脱水类型（失水脱水的敏感性为70%，特异性为68%，OR =5.0（95%CI 1.7-15.1）23，失水脱水的敏感性为78%，特异性为72%，OR =8.9（95%CI 2.5-30.7）（水分和溶质损失脱水）。结论：除了收缩压低，这可能有助于水和溶质丢失脱水的具体诊断，身体体征和尿液标记物对确定老年患者是否脱水几乎没有用处。与体征和尿液标记物相比，唾液渗透压显示出上级诊断准确性，并且可用于评估老年人的失水和水和溶质丧失脱水。特别值得注意的是，唾液29 * Mandarin pt点击这里查看链接参考文献
4 Objectives: Dehydration in older adults contributes to increased morbidity and mortality during 5 hospitalization. As such, early diagnosis of dehydration may improve patient outcome and reduce the burden 6 on healthcare. This prospective study investigated the diagnostic accuracy of routinely used physical signs, 7 and non-invasive markers of hydration in urine and saliva. Design: Prospective diagnostic accuracy study. 8 Setting: Hospital acute medical care unit and emergency department. Participants: One hundred and thirty 9 older adults (59 males, 71 females, mean (SD) age = 78 (9) y). Measurements: Participants with any 10 primary diagnosis underwent a hydration assessment within 30min of admittance to hospital. Hydration 11 assessment comprised seven physical signs of dehydration (tachycardia (>100bpm), low systolic blood 12 pressure (<100mmHg), dry mucous membrane, dry axilla, poor skin turgor, sunken eyes, and long capillary 13 refill time (>2s)), urine color, urine specific gravity (USG), saliva flow rate (SFR) and saliva osmolality. 14 Plasma osmolality (Posm) and the blood urea nitrogen to creatinine ratio (BUN:Cr) were assessed as 15 reference standards of hydration, with 21% of participants classified with water-loss dehydration (Posm 16 >295mOsm/kg), 19% classified with water-and-solute-loss dehydration (BUN:Cr >20) and 60% classified as 17 euhydrated. Results: All physical signs showed poor sensitivity (0-44%) for detecting either form of 18 dehydration, with only low systolic blood pressure demonstrating potential utility for aiding the diagnosis of 19 water-and-solute-loss dehydration (diagnostic OR = 14.7). Neither urine color, USG, nor SFR could 20 discriminate hydration status (area under the receiver operating characteristic curve, AUCROC = 0.49-0.57, 21 P>0.05). In contrast, saliva osmolality demonstrated moderate diagnostic accuracy (AUCROC = 0.76, 22 P<0.001) to distinguish both dehydration types (70% sensitivity, 68% specificity, OR =5.0 (95%CI 1.7-15.1) 23 for water-loss dehydration, and 78% sensitivity, 72% specificity, OR =8.9 (95%CI 2.5-30.7) for water-and24 solute-loss dehydration). Conclusions: With the exception of low systolic blood pressure, which could aid 25 in the specific diagnosis of water-and-solute-loss dehydration, physical signs and urine markers show little 26 utility to determine if an elderly patient is dehydrated. Saliva osmolality demonstrated superior diagnostic 27 accuracy compared with physical signs and urine markers, and may have utility for the assessment of both 28 water-loss and water-and-solute-loss dehydration in older individuals. It is particularly noteworthy that saliva 29 *Manuscript Click here to view linked References