High short-term mortality in hospitalized patients with advanced dementia - Lack of benefit of tube feeding
High short-term mortality in hospitalized patients with advanced dementia - Lack of benefit of tube feeding
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DOI：
10.1001/archinte.161.4.594
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发表时间：
2001-02-26
影响因子：
--
通讯作者：
Morrison, RS
中科院分区：
文献类型：
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作者：
Meier, DE;Ahronheim, JC;Morrison, RS
背景资料：管饲对晚期痴呆住院患者生存率的影响是有争议的。目的：评估初始队列的长期生存率，指标住院期间的管饲放置事件，以及管饲对该组患者生存率的影响。九十-对9名晚期痴呆住院患者和一名可用的替代决策者进行了随访，放置喂食管。测量的其他变量包括预先指示状态、长期初级保健医生的存在、代理决策者的参与程度、入院诊断、既往住院、合并症和诊断相关的组诊断类别。在首次住院期间，50%（51/99）的研究患者放置了新的饲管，31%（31/99）的患者出院时未放置饲管，17%（17/99）的患者在入院时已放置饲管。通过逐步logistic回归分析，新饲管放置的预测因素包括非裔美国人种族（比值比，9.43，95%置信区间，2.1-43.2）和居住在养老院（比值比，4.9; 95%置信区间，1.02-2.5）。99例患者的中位生存期为175天。85例（85%）在指数住院治疗后存活，28例（28%）在末次随访时仍然存活，范围为入组研究后1.3至4.2年。管饲与存活率无关（P= 0.90）。入院诊断感染与较高的死亡率相关（比值比，1.9; 95%置信区间，1.01-3.6）。结论：在这一队列的晚期痴呆住院患者中，接受新的喂养管的风险很高，与非裔美国人的种族，并在疗养院居住，并没有可测量的生存影响。无论有无饲管，这些患者的六个月中位死亡率为50%。
Background: The influence of tube feeding on survival in hospitalized patients with advanced dementia is controversial.Objective: To assess long-term survival in an inception cohort, incident tube feeding placement during the index hospitalization, and the influence of tube feeding on survival in this group of patients.Subjects and Methods: Ninety-nine hospitalized patients with advanced dementia and an available surrogate decision maker were followed up through and after the index hospitalization for mortality and placement of a feeding tube. Other variables measured included advance directive status, presence of a long-term primary care physician, level of involvement of the surrogate decision maker, admitting diagnosis, prior hospitalizations, comorbidities, and diagnosis related group diagnostic category.Results: A new feeding tube was placed in 50% (51/99) of the study patients during the index hospitalization, 31% (31/99) left the hospital without a feeding tube, and 17% (17/99) were admitted with a feeding tube already in place. By stepwise logistic regression analysis, predictors of new feeding tube placement included African American ethnicity (odds ratio, 9.43, 95% confidence interval, 2.1-43.2) and residence in a nursing home (odds ratio, 4.9; 95% confidence interval, 1.02-2.5). Median survival of the 99 patients was 175 days. Eighty-five (85%) survived the index hospitalization, and 28 (28%) were still alive at last follow-up, a range of 1.3 to 4.2 years after enrollment in the study. Tube feeding was not associated with survival (P=.90). An admitting diagnosis of infection was associated with higher mortality (odds ratio, 1.9; 95% confidence interval, 1.01-3.6).Conclusions: In this cohort of hospitalized patients with advanced dementia, risk of receiving a new feeding tube is high, associated with African American ethnicity, and prior residence in a nursing home, and has no measurable influence on survival. With or without a feeding tube, these patients have a 50% six-month median mortality.