Adverse drug reactions as cause of hospital admissions: Results from the Italian Group of Pharmacoepidemiology in the Elderly (GIFA)
Adverse drug reactions as cause of hospital admissions: Results from the Italian Group of Pharmacoepidemiology in the Elderly (GIFA)
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DOI：
10.1046/j.1532-5415.2002.50607.x
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发表时间：
2002-12-01
影响因子：
6.3
通讯作者：
Gambassi, G
中科院分区：
文献类型：
--
作者：
Onder, G;Pedone, C;Gambassi, G
目的：确定老年人群中与药物不良反应(ADR)相关的住院发生率，描述最常见的临床表现和最常见的引起ADR相关住院的药物，并确定这些ADR的独立预测因素。设计：1988年至1997年间进行的多中心药物流行病学调查。集合：在调查期间连续在参与中心住院的28,411名患者。测量：对于每个可疑的ADR，一名医生对其描述、严重性和潜在的责任药物进行编码，结果：患者的平均年龄+/-标准差为70+/-16。入院时共发现1704例ADR。在964例(占所有入院病例的3.4%)中，ADR被认为是导致这些入院的原因。其中187例ADR被编码为严重不良反应。胃肠道不适(19%)是最常见的事件，其次是代谢和出血并发症(9%)。导致这些不良反应最常见的药物是利尿剂、钙通道阻滞剂、非类固醇抗炎药和地高辛。女性(OR=1.30，95%可信区间(CI)=1.10~1.54)、饮酒(OR=1.39，95%CI=1.20~1.60)和用药次数(OR=1.24，95%CI=1.20~1.27)是ADR住院的独立预测因素。对于严重的不良反应，年龄(年龄65-79岁，OR=1.50，95%CI=1.01-2.23；年龄大于或等于80，OR=1.53，95%CI=1.00-2.33)、合并症(OR=1.12，95%CI=1.05-1.20)、用药次数(OR=1.18，(95%CI=1.11~1.25)是唯一的易感因素。结论：老年ADR相关住院风险的最重要决定因素是用药次数。当只考虑严重的不良反应时，风险也与年龄和虚弱有关。
OBJECTIVES: To determine the prevalence of adverse drug reaction (ADR)-related hospital admissions in an older population, to describe the most common clinical manifestations and drugs most frequently responsible for ADR-related hospital admissions, and to identify independent factors predictive of these ADRs.DESIGN: Multicenter pharmacoepidemiology survey conducted between 1988 and 1997.SETTING: Eighty-one academic hospitals throughout Italy.PARTICIPANTS: Twenty-eight thousand four hundred eleven patients consecutively admitted to participating centers during the survey periods.MEASUREMENTS: For each suspected ADR at admission, a physician, who coded description, severity, and potentially responsible drugs, completed a questionnaire.RESULTS: Mean age +/- standard deviation of the patients was 70 +/- 16. One thousand seven hundred four ADRs were identified upon hospital admission. In 964 cases (3.4% of all admissions), ADRs were considered to be the cause of these hospital admissions. Of these, 187 ADRs were coded as severe. Gastrointestinal complaints (19%) represented the most common events, followed by metabolic and hemorrhagic complications (9%). The drugs most frequently responsible for these ADRs were diuretics, calcium channel blockers, nonsteroidal antiinflammatory drugs, and digoxin. Female sex (odds ratio (OR) = 1.30, 95% confidence interval (CI) = 1.10-1.54), alcohol use (OR = 1.39, 95% CI = 1.20-1.60), and number of drugs (OR = 1.24, 95% CI = 1.20-1.27 for each drug increase) were independent predictors of ADR-related hospital admissions. For severe ADRs, age (OR = 1.50, 95% CI = 1.01-2.23 for age 65-79 and OR = 1.53, 95% CI = 1.00-2.33 for age greater than or equal to80, respectively), comorbidity (OR = 1.12, 95% CI = 1.05-1.20 for each point in the Charlson Comorbidity Index), and number of drugs (OR = 1.18, 95% CI = 1.11-1.25 for each drug increase) were the only predisposing factors.CONCLUSIONS: The most important determinant of risk for ADR-related hospital admissions in older patients is number of drugs being taken. When considering only severe ADRs, risk is also related to age and frailty.