在住院治疗后,开发和验证老年人1年死亡率的预后指数
L C Walter1, R J Brand, S R Counsell
1Division of Geriatrics, VA Medical Center 111G, 4150 Clement St, San Francisco, CA 94121, USA. louisew@itsa.ucsf.edu
JAMA
|June 30, 2001
概括
一个新的预后指数准确地预测医院出院后老年患者的1年死亡率. 该工具使用易于获得的信息来识别高风险个体,以获得更好的临床护理和风险调整.
科学领域:
- 老年医学 老年医学
- 临床流行病学临床流行病学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 老年患者经常经历功能衰退和住院后高死亡率.
- 现有的预后工具对于老年人医院后死亡率是有限的.
研究的目的:
- 开发和验证用于预测医院出院后老年人1年死亡率的预后指数.
- 为了利用指数的排放时随时可用的信息.
主要方法:
- 来自两项研究 (1993-1997) 的前性数据,随访时间为一年.
- 开发了1495名患者 (≥70岁) 的预后指数,并对1427名患者进行了验证.
- 确定了风险因素,包括人口统计,ADL依赖,并发症,住院和实验室值.
主要成果:
- 确定了六个独立的风险因素:男性性别,ADL依赖,充血性心力衰竭,癌症,肌素和白蛋白水平.
- 风险得分将患者分层分成死亡率组 (例如,衍生队列中的13%与68%).
- 该指数在导出和验证队列中显示出良好的区别 (AUC 0.75-0.79).
结论:
- 一个简单的,附加的预后指数有效地分层了退院后老年医疗患者的1年死亡风险.
- 该指数显示了良好的区分,校准和对不同临床环境的概括性.
- 这种工具可以帮助老年患者的临床决策和风险调整.
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