Development and validation of a risk model for predicting adverse drug reactions in older people during hospital stay: Brighton Adverse Drug Reactions Risk (BADRI) model.
Development and validation of a risk model for predicting adverse drug reactions in older people during hospital stay: Brighton Adverse Drug Reactions Risk (BADRI) model.
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DOI：
10.1371/journal.pone.0111254
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Davies G
中科院分区：
文献类型：
--
作者：
Tangiisuran B;Scutt G;Stevenson J;Wright J;Onder G;Petrovic M;van der Cammen TJ;Rajkumar C;Davies G
老年患者发生药物不良反应 (ADR) 的风险增加。特别值得关注的是最年长的老年人，他们的人口不断增长。拥有经过验证的临床工具来识别住院期间有发生 ADR 风险的老年患者，将使医护人员能够采取措施降低发生此类事件的风险。当前的研究旨在 (1) 开发和 (2) 验证 ADR 风险预测模型。我们结合使用单变量分析和多变量二元逻辑回归来确定英国一家教学医院的老年人群中发生 ADR 的临床风险因素。最终的 ADR 风险模型随后在欧洲人群（欧洲数据集）中进行了验证。 690 名患者（中位年龄 85 岁）参与了该研究的开发阶段。这些患者的 95 份 ADR 报告得到了独立审查的证实。通过多变量分析确定了五个临床变量，并将其包含在我们的最终模型中；每个变量的得分为 1。内部验证的 AUROC 为 0.74，敏感性为 80%，特异性为 55%。在外部验证阶段，AUROC 为 0.73，敏感性和特异性值分别为 84% 和 43%。我们开发并成功验证了一个简单的模型，在中位年龄为 85 岁（即年龄最大的老年人）的患者群体中使用 ADR 风险评分。该模型基于 5 个临床变量（≥8 种药物、高脂血症、白细胞计数升高、抗糖尿病药物的使用、住院时间≥12 天），其中一些变量以前未曾报道过。
Older patients are at an increased risk of developing adverse drug reactions (ADR). Of particular concern are the oldest old, which constitute an increasingly growing population. Having a validated clinical tool to identify those older patients at risk of developing an ADR during hospital stay would enable healthcare staff to put measures in place to reduce the risk of such an event developing. The current study aimed to (1) develop and (2) validate an ADR risk prediction model. We used a combination of univariate analysis and multivariate binary logistic regression to identify clinical risk factors for developing an ADR in a population of older people from a UK teaching hospital. The final ADR risk model was then validated in a European population (European dataset). Six-hundred-ninety patients (median age 85 years) were enrolled in the development stage of the study. Ninety-five reports of ADR were confirmed by independent review in these patients. Five clinical variables were identified through multivariate analysis and included in our final model; each variable was attributed a score of 1. Internal validation produced an AUROC of 0.74, a sensitivity of 80%, and specificity of 55%. During the external validation stage the AUROC was 0.73, with sensitivity and specificity values of 84% and 43% respectively. We have developed and successfully validated a simple model to use ADR risk score in a population of patients with a median age of 85, i.e. the oldest old. The model is based on 5 clinical variables (≥8 drugs, hyperlipidaemia, raised white cell count, use of anti-diabetic agents, length of stay ≥12 days), some of which have not been previously reported.
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