Predicting the Readmission and Mortality in Older Patients Hospitalized with Pneumonia with Preadmission Frailty
Predicting the Readmission and Mortality in Older Patients Hospitalized with Pneumonia with Preadmission Frailty
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DOI：
10.14283/jfa.2022.36
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发表时间：
2022-04
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通讯作者：
K. Yamada;K. Iwata;Y. Yoshimura;H. Ota;Y. Oki;Y. Mitani;Y. Yamada;A. Yamamoto;K. Ono;A. Honda;T. Kitai;R. Tachikawa;N. Kohara;K. Tomii;A. Ishikawa
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作者：
K. Yamada;K. Iwata;Y. Yoshimura;H. Ota;Y. Oki;Y. Mitani;Y. Yamada;A. Yamamoto;K. Ono;A. Honda;T. Kitai;R. Tachikawa;N. Kohara;K. Tomii;A. Ishikawa
在老年人中，虚弱已被认为是一个重要的预后因素。然而，只有少数研究关注多维虚弱作为肺炎住院患者死亡率和再入院的预测因素。目的探讨老年肺炎患者入院前虚弱程度与住院后临床结局的关系。设计：单中心、回顾性病例对照研究。地点：日本科比急性期医院。参与者本研究包括654例连续老年肺炎住院患者。入院前的虚弱状态使用总Kihon检查表（KCL）评分进行评估，该评分已被用作自填式问卷，以评估综合虚弱，包括身体、社会和认知状态。主要结局是6个月死亡率和出院后再入院率的综合结果。结果共分析了330例患者（中位年龄：79岁，男性; 70.4%，中位数总KCL评分; 10分），其中68例再次入院，10例在6个月内死亡。多变量分析后，总KCL评分与6个月死亡率和再入院率相关（校正风险比，1.07; 95%置信区间，1.02-1.12; p = 0.006）。通过受试者工作特征曲线分析确定的KCL总分的截止值为15分（曲线下面积= 0.610）。KCL总分≥ 15分组的再入院率或死亡率显著高于KCL总分< 15分组（p < 0.001）。结论老年肺炎患者入院前虚弱状态是影响再入院和住院后生存的独立危险因素。
Background In older people, frailty has been recognized as an important prognostic factor. However, only a few studies have focused on multidimensional frailty as a predictor of mortality and readmission among inpatients with pneumonia. Objective The present study aimed to assess the association between preadmission frailty and clinical outcomes after the hospitalization of older patients with pneumonia. Design Single-center, retrospective case-control study. Setting Acute phase hospital at Kobe, Japan. Participants The present study included 654 consecutive older inpatients with pneumonia. Measurements Frailty status before admission was assessed using total Kihon Checklist (KCL) score, which has been used as a self-administered questionnaire to assess comprehensive frailty, including physical, social, and cognitive status. The primary outcome was a composited 6-month mortality and readmission after discharge. Results In total, 330 patients were analyzed (median age; 79 years, male; 70.4%, median total KCL score; 10 points), of which 68 were readmitted and 10 died within 6 months. After multivariate analysis, total KCL score was associated with a composited 6-month mortality and readmission (adjusted hazard ratio, 1.07; 95% confidence interval, 1.02–1.12; p = 0.006). The cutoff value for total KCL score determined by receiver operating characteristic curve analysis was 15 points (area under the curve = 0.610). The group with a total KCL score ≥ 15 points had significantly higher readmission or mortality rates than the groups with a total KCL score < 15 points (p < 0.001). Conclusions Preadmission frailty status in older patients with pneumonia was an independent risk factor for readmission and survival after hospitalization.