Frailty Index and functional level upon admission predict hospital outcomes: an interRAI-based cohort study of older patients in post-acute care hospitals
Frailty Index and functional level upon admission predict hospital outcomes: an interRAI-based cohort study of older patients in post-acute care hospitals
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DOI：
10.1186/s12877-020-01550-7
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发表时间：
2020-05-05
期刊：
影响因子：
4.1
通讯作者：
Jamsen, Esa
中科院分区：
文献类型：
--
作者：
Kerminen, Hanna;Huhtala, Heini;Jamsen, Esa
背景：入院时的老年评估可能揭示导致住院老年患者不良结局的因素。本研究的目的是从interRAI急性期后护理工具（interRAI-PAC）中推导出虚弱指数（FI-PAC），并分析FI-PAC和interRAI量表对医院结局的预测能力。方法本回顾性队列研究通过将来自interRAI-PAC的患者数据与两家急性后护理医院的出院记录相结合进行。FI-PAC来自57个符合虚弱指数标准的变量。使用logistic回归和ROC曲线分析FI-PAC和interRAI-PAC量表（ADLH用于日常生活活动，CPS用于认知，DRS用于情绪，CHESS用于健康状态稳定性）与住院结局（延长住院时间>= 90天，住院期间急诊入院和住院死亡率）的相关性。结果该队列包括2188例患者（平均年龄（SD）84.7（6.3）岁），他们在两家急诊后护理医院住院。大多数患者（n = 1691，77%）出院并回家。他们的中位住院时间为35天（四分位数范围18-87天），409例患者（24%）住院时间延长。在住院期间，204名患者（9%）被急诊科收治，231名患者（11%）死亡。FI-PAC呈正态分布（平均值（SD）0.34（0.15））。FI-PAC每增加0.1分，延长住院时间（比值比[95% CI] 1.91 [1.73 & x2500;2.09]）、急诊入院（1.24 [1.11 & x2500;1.37]）和院内死亡（1.82 [1.63 & x2500;2.03]）的可能性增加。预测住院时间延长和住院死亡率的最佳工具是FI-PAC和ADLH量表（AUC分别为0.75 vs 0.72和0.73 vs 0.73）。有没有差异的预测能力的interRAI量表和FI-PAC急诊入院。结论：由interRAI-PAC得出的虚弱指数可预测不良的住院结局。其预测能力与ADLH量表相似，而其他interRAI-PAC量表的预测价值较低。在临床实践中，功能能力评估是评估患者预后的简单方法。
Background Geriatric assessment upon admission may reveal factors that contribute to adverse outcomes in hospitalized older patients. The purposes of this study were to derive a Frailty Index (FI-PAC) from the interRAI Post-Acute Care instrument (interRAI-PAC) and to analyse the predictive ability of the FI-PAC and interRAI scales for hospital outcomes. Methods This retrospective cohort study was conducted by combining patient data from interRAI-PAC with discharge records from two post-acute care hospitals. The FI-PAC was derived from 57 variables that fulfilled the Frailty Index criteria. Associations of the FI-PAC and interRAI-PAC scales (ADLH for activities of daily living, CPS for cognition, DRS for mood, and CHESS for stability of health status) with hospital outcomes (prolonged hospital stay >= 90 days, emergency department admission during the stay, and in-hospital mortality) were analysed using logistic regression and ROC curves. Results The cohort included 2188 patients (mean age (SD) 84.7 (6.3) years) who were hospitalized in two post-acute care hospitals. Most patients (n = 1691, 77%) were discharged and sent home. Their median length of stay was 35 days (interquartile range 18-87 days), and 409 patients (24%) had a prolonged hospital stay. During their stay, 204 patients (9%) were admitted to the emergency department and 231 patients (11%) died. The FI-PAC was normally distributed (mean (SD) 0.34 (0.15)). Each increase of 0.1 point in the FI-PAC increased the likelihood of prolonged hospital stay (odds ratio [95% CI] 1.91 [1.73 & x2500;2.09]), emergency admission (1.24 [1.11 & x2500;1.37]), and in-hospital death (1.82 [1.63 & x2500;2.03]). The best instruments for predicting prolonged hospital stay and in-hospital mortality were the FI-PAC and the ADLH scale (AUC 0.75 vs 0.72 and 0.73 vs 0.73, respectively). There were no differences in the predictive abilities of interRAI scales and the FI-PAC for emergency department admission. Conclusions The Frailty Index derived from interRAI-PAC predicts adverse hospital outcomes. Its predictive ability was similar to that of the ADLH scale, whereas other interRAI-PAC scales had less predictive value. In clinical practice, assessment of functional ability is a simple way to assess a patient's prognosis.