Increasing Prevalence of Frailty and Its Association with Readmission and Mortality Among Hospitalized Patients with IBD.
Increasing Prevalence of Frailty and Its Association with Readmission and Mortality Among Hospitalized Patients with IBD.
复制标题
DOI：
10.1007/s10620-020-06746-w
复制
发表时间：
2021-12
影响因子：
3.1
通讯作者：
Lebwohl B
中科院分区：
文献类型：
--
作者：
Faye AS;Wen T;Soroush A;Ananthakrishnan AN;Ungaro R;Lawlor G;Attenello FJ;Mack WJ;Colombel JF;Lebwohl B
虽然年龄通常被用作临床风险分层工具，但最近的数据表明，不良后果是由虚弱而不是实足年龄驱动的。在这项全国性队列研究中，我们评估了IBD住院患者中虚弱的患病率，以及与30天再入院和死亡率相关的因素。使用全国再入院数据库，我们检查了2010-2014年所有IBD住院患者。基于索引入院，我们使用先前验证过的ICD代码定义了IBD和脆弱性。我们使用单变量和多变量回归来评估与全因30天再入院和30天再入院死亡率相关的危险因素。从2010年到2014年，共有1405529例IBD患者入院，其中152974例（10.9%）被归类为虚弱。在此期间，虚弱的患病率逐年增加，从2010年的10.20%（27,594）增加到2014年的11.45%（33,507）。在多变量分析中，调整相关临床因素后，虚弱是再入院（aRR 1.16, 95% CI: 1.14-1.17）和再入院死亡率（aRR 1.12, 95% CI 1.02-1.23）的独立预测因子。在按照IBD亚型、入院特征（手术与非手术）、年龄（患者≥60岁）以及排除作为虚弱指标的营养不良、体重减轻和大便失禁进行分层后，虚弱仍与再入院相关。相反，我们发现年龄越大，再入院风险越低。与年龄、合并症和入院严重程度无关的虚弱与IBD患者再入院和死亡的高风险相关，并且患病率正在增加。鉴于虚弱是一个潜在的可改变的危险因素，未来的研究需要前瞻性地评估IBD患者群体中的虚弱。
Although age is often used as a clinical risk stratification tool, recent data has suggested that adverse outcomes are driven by frailty rather than chronological age. In this nationwide cohort study, we assessed the prevalence of frailty, and factors associated with 30-day readmission and mortality among hospitalized IBD patients. Using the Nationwide Readmission Database, we examined all patients with IBD hospitalized from 2010–2014. Based on index admission, we defined IBD and frailty using previously validated ICD codes. We used univariable and multivariable regression to assess risk factors associated with all-cause 30-day readmission and 30-day readmission mortality. From 2010–2014, 1,405,529 IBD index admissions were identified, with 152,974 (10.9%) categorized as frail. Over this time period, the prevalence of frailty increased each year from 10.20% (27,594) in 2010 to 11.45% (33,507) in 2014. On multivariable analysis, frailty was an independent predictor of readmission (aRR 1.16, 95% CI: 1.14–1.17), as well as readmission mortality (aRR 1.12, 95% CI 1.02–1.23) after adjusting for relevant clinical factors. Frailty also remained associated with readmission after stratification by IBD subtype, admission characteristics (surgical vs. non-surgical), age (patients ≥ 60 years-old), and when excluding malnutrition, weight loss, and fecal incontinence as frailty indicators. Conversely, we found older age to be associated with a lower risk of readmission. Frailty, independent of age, comorbidities, and severity of admission, is associated with a higher risk of readmission and mortality among IBD patients, and is increasing in prevalence. Given frailty is a potentially modifiable risk factor, future studies prospectively assessing frailty within the IBD patient population are needed.
登录
查看更多内容
影响因子：
33.9
作者：
Malarcher, Christopher A.;Wheaton, Anne G.;Croft, Janet B.
通讯作者：
Croft, Janet B.
影响因子：
4.9
作者：
Desai, Amit;Zator, Zachary A.;de Silva, Punyanganie;Nguyen, Deanna D.;Korzenik, Joshua;Yajnik, Vijay;Ananthakrishnan, Ashwin N.
通讯作者：
Ananthakrishnan, Ashwin N.
影响因子：
2.6
作者：
Goel, Alexander N.;Lee, Jivianne T.;Suh, Jeffrey D.
通讯作者：
Suh, Jeffrey D.
DOI：
10.1136/bmj.k497
发表时间：
2018-02-27
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Berry JG;Gay JC;Joynt Maddox K;Coleman EA;Bucholz EM;O'Neill MR;Blaine K;Hall M
通讯作者：
Hall M
影响因子：
2.9
作者：
Johnson SL;Bartels CM;Palta M;Thorpe CT;Weiss JM;Smith MA
通讯作者：
Smith MA