Frailty Is Independently Associated with Mortality and Readmission in Hospitalized Patients with Inflammatory Bowel Diseases.
Frailty Is Independently Associated with Mortality and Readmission in Hospitalized Patients with Inflammatory Bowel Diseases.
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DOI：
10.1016/j.cgh.2020.08.010
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发表时间：
2021-10
期刊：
影响因子：
--
通讯作者：
Singh S
中科院分区：
文献类型：
--
作者：
Qian AS;Nguyen NH;Elia J;Ohno-Machado L;Sandborn WJ;Singh S
在权衡炎症性肠病(IBD)患者并发症的风险和治疗的益处时，必须考虑老年。我们进行了一项具有全国代表性的队列研究，以评估虚弱对IBD患者的负担、费用和住院原因的独立影响。我们搜索了全国再入院数据库，以确定47,402名IBD患者，他们从2013年1月到6月住院，并跟踪调查到2013年12月31日。根据经过验证的医院脆弱风险评分系统，15,507名患者在指数入院时被认为是虚弱的，31,895名患者被认为是非虚弱的。我们评估了脆弱对纵向住院负担和费用、住院死亡率、再入院和手术风险以及再入院原因的独立影响。在10个月的中位随访时间上，调整了年龄、性别、收入、共病指数、抑郁、肥胖、严重程度和住院指征，虚弱与57%的死亡风险(调整后的风险比[AHR]，1.57；95%的可信区间，1.34-1.83)、21%的全原因再住院风险(调整后的风险比[HR]，1.21；95%的可信区间，1.17-1.25)和22%的重症IBD再住院风险(AHR，1.22；95%可信区间为1.16-1.29)。患有IBD的虚弱患者每年住院天数更多(非虚弱患者的中位数为9天；四分位数范围为4-18天；中位数为5天；四分位数范围为3-10天；P<；.01)，住院费用较高(17,791美元；四分位范围为8368-38,942美元，非虚弱患者为10,924美元；四分位数范围为5571-22,632美元；P<；01)。感染，而不是IBD，是虚弱患者住院的主要原因。在IBD患者中，虚弱与较高的死亡率和住院负担独立相关；感染是住院的主要原因。在治疗方法上应考虑虚弱，特别是在老年IBD患者。这些幻灯片中的插图是AGA的独有财产，仅供您的CGH图形摘要使用。不得复制或重新分发这些插图。
Old age must be considered in weighing the risks of complications vs benefits of treatment for patients with inflammatory bowel diseases (IBD). We conducted a nationally representative cohort study to estimate the independent effects of frailty on burden, costs, and causes for hospitalization in patients with IBD. We searched the Nationwide Readmissions Database to identify 47,402 patients with IBD, hospitalized from January through June 2013 and followed for readmission through December 31, 2013. Based on a validated hospital frailty risk scoring system, 15,507 patients were considered frail and 31,895 were considered non-frail at index admission. We evaluated the independent effect of frailty on longitudinal burden and costs of hospitalization, inpatient mortality, risk of readmission and surgery, and reasons for readmission. Over a median follow-up time of 10 months, adjusting for age, sex, income, comorbidity index, depression, obesity, severity, and indication for index hospitalization, frailty was independently associated with 57% higher risk of mortality (adjusted hazard ratio [aHR], 1.57; 95% CI, 1.34–1.83), 21% higher risk of all-cause readmission (adjusted hazard ratio [HR], 1.21; 95% CI, 1.17–1.25), and 22% higher risk of readmission for severe IBD (aHR, 1.22; 95% CI, 1.16–1.29). Frail patients with IBD spent more days in the hospital annually (median 9 days; interquartile range, 4–18 days vs median 5 days for non-frail patients; interquartile range, 3–10 days; P<.01) with higher costs of hospitalization ($17,791; interquartile range, $8368–$38,942 vs $10,924 for non-frail patients, interquartile range, $5571–$22,632; P<.01). Infections, rather than IBD, were the leading cause of hospitalization for frail patients. Frailty is independently associated with higher mortality and burden of hospitalization in patients with IBD; infections are the leading cause of hospitalization. Frailty should be considered in treatment approach, especially in older patients with IBD. The illustrations in these slides are the sole property of the AGA and are provided here for use within your CGH graphical abstract only. These illustrations may not be copied or redistributed.
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