Adverse drug reactions in older patients during hospitalisation: are they predictable?
Adverse drug reactions in older patients during hospitalisation: are they predictable?
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DOI：
10.1093/ageing/afs046
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发表时间：
2012-11-01
期刊：
影响因子：
6.7
通讯作者：
O'Mahony, Denis
中科院分区：
文献类型：
--
作者：
O'Connor, Marie N.;Gallagher, Paul;O'Mahony, Denis
背景：药物不良反应（ADR）是老年人发病和医疗保健利用的主要原因。GerontoNet ADR风险评分旨在识别住院期间存在ADR风险的老年人。我们的目的是评估这一评分的临床适用性，并确定其他变量，预测住院老年people.Methods的药物不良反应：我们前瞻性研究了513急性病患者年龄≥ 65岁。计算所有患者的GerontoNet ADR风险评分。通过患者和医生咨询以及病例记录分析确定ADR。构建受试者操作特征（ROC）曲线以检验GerontoNet风险评分预测ADR的能力。多因素Logistic回归分析个体变量对ADRs.Results存在的影响：在医院ADRs确定在135例（26%）。ROC曲线下面积为0.62（95%CI：0.57-0.68）。增加ADR风险的变量包括（i）肾衰竭（OR：1.81，95% CI：1.12-2.92），（ii）药物治疗数量增加（OR：1.09，95% CI：1.02-1.17）（iii）用药不当（OR：2.40，95%CI：1.26-4.50）和（iv）年龄≥ 75岁（OR：2.12，95%CI：1.23-3.70）。不适当的药物和年龄的增加也会增加ADR的风险。
Background: adverse drug reactions (ADRs) are a major cause of morbidity and healthcare utilisation in older people. The GerontoNet ADR risk score aims to identify older people at risk of ADRs during hospitalisation. We aimed to assess the clinical applicability of this score and identify other variables that predict ADRs in hospitalised older people.Methods: we prospectively studied 513 acutely ill patients aged >= 65 years. The GerontoNet ADR risk score was calculated for all patients. ADRs were identified through patient and physician consultation together with analysis of case notes. Receiver operator characteristic (ROC) curves were constructed to test the ability of the GerontoNet risk score to predict ADRs. Multivariate logistic regression examined the influence of individual variables on the presence of ADRs.Results: in-hospital ADRs were identified in 135 patients (26%). The area under the ROC curve was 0.62 (95% CI: 0.57-0.68). Variables which increased ADR risk include (i) renal failure (OR: 1.81, 95% CI: 1.12-2.92), (ii) increasing number of medications (OR: 1.09, 95% CI: 1.02-1.17) (iii) inappropriate medications (OR: 2.40, 95% CI: 1.26-4.50) and (iv) age >= 75 years (OR: 2.12, 95% CI: 1.23-3.70).Conclusion: the GerontoNet ADR risk score incorrectly classified 38% of patients as low risk. Inappropriate medications and increasing age also contribute to ADR risk.