Identifying mortality risks in patients with opioid use disorder using brief screening assessment: Secondary mental health clinical records analysis.
Identifying mortality risks in patients with opioid use disorder using brief screening assessment: Secondary mental health clinical records analysis.
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DOI：
10.1016/j.drugalcdep.2016.04.036
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发表时间：
2016-07-01
影响因子：
4.2
通讯作者：
Hayes RD
中科院分区：
文献类型：
--
作者：
Bogdanowicz KM;Stewart R;Chang CK;Downs J;Khondoker M;Shetty H;Strang J;Hayes RD
迅速查明有风险的人是关键。我们对4488例阿片类药物依赖患者的风险和死亡率进行了临床评估。成瘾特异性风险评估有助于预测死亡率。有明显自杀倾向的患者不入院会增加死亡率。风险评估被广泛使用，但其预测阿片类药物使用障碍（OUD）治疗结果的能力仍不清楚。因此，目的是调查成瘾特异性简短风险筛查是否能有效识别高死亡率风险群体，以及风险评估后的后续临床行动是否会影响死亡率水平。阿片类药物使用障碍（OUD）患者是在南伦敦和莫兹利病例登记处发现的。通过与国家死亡率数据集的数据库链接确定死亡人数。采用考克斯和竞争风险回归模型对4488例OUD患者的简要风险评估域与全因和过量死亡率之间的关联进行建模，随访时间长达6年，其中登记了227例死亡。数据分层入院一般精神卫生服务。全因死亡率与不安全注射（HR 1.53，95% CI 1.10-2.11）和临床评估的意外过量可能性（HR 1.48，95% CI 1.00-2.19）显著相关。过量死亡率与不安全注射（SHR 2.52，95%CI 1.11-5.70）和临床评估的自杀倾向（SHR 2.89，95%CI 1.38-6.03）显著相关。在风险评估后2个月内未接受精神卫生服务的OUD患者中，自杀倾向与死亡风险增加2倍相关（HR 2.03，95%CI 1.67-3.24）。诊断特异性简要风险筛查可以识别全因和过量死亡风险增加的OUD患者亚组。OUD患者，自杀倾向明显，谁不承认进入服务特别脆弱。
Prompt identification of those at risk is key. We examine clinical appraisal of patient risks and mortality in 4488 opioid dependent patients. Addiction-specific risk assessment is useful in predicting mortality. Non-admission of patients where suicidality is evident increases mortality. Risk assessments are widely used, but their ability to predict outcomes in opioid use disorder (OUD) treatment remains unclear. Therefore, the aim was to investigate if addiction-specific brief risk screening is effective in identifying high mortality risk groups and if subsequent clinical actions following risk assessment impacts on mortality levels. Opioid use disorder (OUD) patients were identified in the South London and Maudsley Case Register. Deaths were identified through database linkage to the national mortality dataset. Cox and competing-risk regression were used to model associations between brief risk assessment domains and all-cause and overdose mortality in 4488 OUD patients, with up-to 6-year follow-up time where 227 deaths were registered. Data were stratified by admission to general mental health services. All-cause mortality was significantly associated with unsafe injecting (HR 1.53, 95% CI 1.10–2.11) and clinically appraised likelihood of accidental overdose (HR 1.48, 95% CI 1.00–2.19). Overdose-mortality was significantly associated with unsafe injecting (SHR 2.52, 95% CI 1.11–5.70) and clinically appraised suicidality (SHR 2.89, 95% CI 1.38–6.03). Suicidality was associated with a twofold increase in mortality risk among OUD patients who were not admitted to mental health services within 2 months of their risk assessment (HR 2.03, 95% CI 1.67–3.24). Diagnosis-specific brief risk screening can identify OUD patient subgroups at increased risk of all-cause and overdose mortality. OUD patients, where suicidality is evident, who are not admitted into services are particularly vulnerable.