Frailty status at admission to hospital predicts multiple adverse outcomes
Frailty status at admission to hospital predicts multiple adverse outcomes
复制标题
DOI：
10.1093/ageing/afx081
复制
发表时间：
2017-09-01
期刊：
影响因子：
6.7
通讯作者：
Rockwood, Kenneth
中科院分区：
文献类型：
--
作者：
Hubbard, Ruth E.;Peel, Nancye M.;Rockwood, Kenneth
目的：提出脆弱性作为健康状况的总结性测量和个体脆弱性的标志。我们的目的是调查一个脆弱指数（FI）的鉴别能力，来自于interRAI综合老年评估急性护理（AC）在多个不良住院outcomes.Methods：在这项前瞻性队列研究中，一个FI来自1,418例患者>= 70岁，在澳大利亚的11家医院。在入院和出院时由受过训练的护士进行interRAI-AC，他们还每天对患者进行老年综合征筛查。结果：在调整后的logistic回归模型中，FI增加0.1与住院时间>28天的可能性增加显著相关（比值比[OR]：1.29 [1.10-1.52]），新出院至老年护理住宅（OR：1.31 [1.10-1.57]），院内福尔斯（OR：1.29 [1.10-1.50]），谵妄（OR：2.34 [2.08-2.63]）、压疮发生率（OR：1.51 [1.23-1.87]）和住院死亡率（OR：2.01 [1.66-2.42]）。对于这些不良结果中的每一个，发生最佳灵敏度和特异性的临界点是FI > 0.40。特异性高于敏感性，阳性预测值为7-52%，阴性预测值为88- 98%。FI-AC没有显着相关再入院hospital.Conclusions：interRAI-AC可以用来获得一个单一的分数，预测多种不良后果的老年住院患者。的比分
Aims: frailty is proposed as a summative measure of health status and marker of individual vulnerability. We aimed to investigate the discriminative capacity of a frailty index (FI) derived from interRAI Comprehensive Geriatric Assessment for Acute Care (AC) in relation to multiple adverse inpatient outcomes.Methods: in this prospective cohort study, an FI was derived for 1,418 patients >= 70 years across 11 hospitals in Australia. The interRAI-AC was administered at admission and discharge by trained nurses, who also screened patients daily for geriatric syndromes.Results: in adjusted logistic regression models an increase of 0.1 in FI was significantly associated with increased likelihood of length of stay >28 days (odds ratio [OR]: 1.29 [1.10-1.52]), new discharge to residential aged care (OR: 1.31 [1.10-1.57]), in-hospital falls (OR: 1.29 [1.10-1.50]), delirium (OR: 2.34 [2.08-2.63]), pressure ulcer incidence (OR: 1.51 [1.23-1.87]) and inpatient mortality (OR: 2.01 [1.66-2.42]). For each of these adverse outcomes, the cut-point at which optimal sensitivity and specificity occurred was for an FI > 0.40. Specificity was higher than sensitivity with positive predictive values of 7-52% and negative predictive values of 88-98%. FI-AC was not significantly associated with readmissions to hospital.Conclusions: the interRAI-AC can be used to derive a single score that predicts multiple adverse outcomes in older inpatients. A score of