出院时衰弱状态与老年脓毒症幸存者90 d内非计划再入院的相关性研究

doi:10.3969/j.issn.1003-9198.2022.07.007

摘要/Abstract

摘要： 目的探讨老年脓毒症幸存者出院时不同衰弱状态与出院后90 d内非计划再入院的关系。方法选取2020年1月至2021年6月在海南医学院第二附属医院住院的老年脓毒症幸存者331例为前瞻性研究随访队列,连续随访90 d,以首次非计划再入院或完成随访为观察终点。根据出院后90 d内是否发生非计划再入院,将老年脓毒症幸存者分为再入院组107例和未再入院组224例。根据出院时衰弱状态,将老年脓毒症幸存者分为非衰弱组(n=150)、衰弱前期组(n=141)、衰弱组(n=40)。收集所有病人的临床资料,采用单因素分析、Kaplan-Meier曲线分析、多因素Cox风险比例回归模型分析探讨老年脓毒症幸存者出院时衰弱状态与出院后90 d内非计划再入院的关系。结果再入院组病人的年龄、BMI、序贯器官衰竭估计(SOFA)评分、合并脑血管疾病比例、衰弱前期比例和衰弱比例明显高于未再入院组(P＜0.05)。老年脓毒症幸存者出院后90 d内非计划再入院的累积发生率随着衰弱程度的增高而增加,差异有统计学意义(P_趋势＜0.001)。Kaplan-Meier曲线分析也显示,非衰弱组、衰弱前期组、衰弱组出院后90 d内非计划再入院的累积发生率差异有统计学意义(χ²=80.800,P＜0.001)。以非衰弱组为参照,多因素Cox风险比例回归模型分析结果显示,在调整了年龄及其他相关指标后,衰弱前期及衰弱是老年脓毒症幸存者出院后90 d内非计划再入院的影响因素[HR(95%CI)分别为2.008(1.225～3.291)、6.419(3.416～12.061),P＜0.05]。结论在老年脓毒症幸存者中,衰弱程度越高,出院后90 d内非计划再入院风险越高。

关键词: 老年人, 脓毒症, 衰弱, 非计划性再入院, 影响因素

Abstract: Objective To investigate the correlation between different frailty status at discharge and unplanned readmission within 90 days after discharge in the elderly survivors from sepsis. Methods A total of 331 elderly survivors from sepsis admitted to the Second Affiliated Hospital of Hainan Medical University from January 2020 to June 2021 were enrolled as the prospective follow-up cohort. The follow-up was carried out consecutively for 90 days, and the observation ended at the first unplanned readmission or completion of follow-up. Based on whether unplanned readmission occurred within 90 days after discharge, the elderly survivors from sepsis were divided into readmission group (n=107) and non-readmission group (n=224). According to the frailty status at discharge, the elderly patients were divided into non-frailty group (n=150), pre-frailty group (n=141) and frailty group (n=40). The clinical data of all the patients were collected. Univariate analysis, Kaplan-Meier curve analysis, multivariate Cox risk proportional regression were used to explore the correlation between frailty status at discharge and unplanned readmission within 90 days after discharge. Results The age, body mass index (BMI), Sequential Organ Failure Assessment (SOFA) score, and the proportion of cerebrovascular disease, pre-frailty and frailty in readmission group were significantly higher than those in non-readmission group (P＜0.05). The accumulated incidence of unplanned readmission within 90 days after discharge increased with the increase of frailty status in the elderly survivors from sepsis (P_trend<0.001). Kaplan-Meier curve analysis showed that the difference of accumulated incidence of unplanned readmission within 90 days after discharge were statistically significant among the patients with different frailty status (χ²=80.800, P<0.001). Taking the non-frail group as the reference, multivariate Cox risk proportional regression showed that after adjusting for age and other related indicators, pre-frailty (HR=2.008, 95%CI:1.225-3.291, P<0.05) and frailty (HR=6.419, 95%CI:3.416-12.061, P<0.05) were the influencing factors of unplanned readmission within 90 days after discharge in the elderly survivors from sepsis. Conclusions The frailty status shows significant influence on unplanned readmission within 90 days after discharge in the elderly survivors from sepsis at a degree-dependent manner.

Key words: aged, sepsis, frailty, unplanned readmission, influcing factor

中图分类号:

R592
R631

陈钰霖, 李芬, 邢柏. 出院时衰弱状态与老年脓毒症幸存者90 d内非计划再入院的相关性研究[J]. 实用老年医学, 2022, 36(7): 675-679.

CHEN Yu-lin, LI Fen, XING Bo. Correlation between frailty status at discharge and unplanned readmission within 90 days in elderly survivor from sepsis[J]. Practical Geriatrics, 2022, 36(7): 675-679.

参考文献

[1] DEB P, MURTAUGH C M, BOWLES K H, et al. Does early follow-up improve the outcomes of sepsis survivors discharged to home health care?[J]. Med Care, 2019, 57(8):633-640.
[2] JIANG Z Y, BO L L, XU Z H, et al. An explainable machine learning algorithm for risk factor analysis of in-hospital mortality in sepsis survivors with ICU readmission[J]. Comput Methods Programs Biomed, 2021, 204:106040.
[3] WEINREICH M, STYRVOKY K, CHANG S, et al. Sepsis at a safety net hospital: risk factorsassociated with 30-day readmission[J]. J Intensive Care Med, 2019, 34(1):1017-1022.
[4] STENHOLT P, ABDULLAH S, SØRENSEN R, et al. Independent predictors for 90-day readmission of emergency department patients admitted with sepsis: a prospective cohort study[J]. BMC Infect Dis, 2021, 21(1):315.
[5] BOWLES K, MURTAUGH C, JORDAN L, et al. Sepsis survivors transitioned to home health care: characteristics and early readmission risk factors[J]. J Am Med Dir Assoc, 2020, 21(1):84-90.
[6] GADRE S, SHAH M, MIRELES-CABODEVILA E, et al. Epidemiology and predictors of 30-day readmission in patients with sepsis[J]. Chest, 2019, 155(3):483-490.
[7] ANDREASEN J, AADAHL M, SØRENSEN E, et al. Associations and predictions of readmission or death in acutely admitted older medical patients using self-reported frailty and functional measures. A Danish cohort study[J]. Arch Gerontol Geriatr, 2018, 76 (1):65-72.
[8] 董家辉, 王玲玲, 熊日成, 等. 基于衰弱综合征建立老年脓毒症患者180 d病死率的预测评分[J]. 中华危重病急救医学, 2021, 33(3):257-262.
[9] SEYMOUR C W, LIU V X, IWASHYNA T J, et al. Assessment of clinical criteria for sepsis:for the third international consensus definitions for sepsis and septic shock (Sepsis-3)[J]. JAMA, 2016, 315(8):762-774.
[10] 中华医学会老年医学分会. 老年患者衰弱评估与干预中国专家共识[J]. 中华老年医学杂志, 2017, 36(3):251-256.
[11] GADRE S, SHAH M, MIRELES-CABODEVILA E, et al. Epidemiology and predictors of 30-day readmission in patients with sepsis[J]. Chest, 2019, 155(3):483-490.
[12] OKADA Y, KIGUCHI T, OKADA A, et al. Predictive value of sarcopenic findings in the psoas muscle on CT imaging among patients with sepsis[J]. Am J Emerg Med, 2021, 47:180-186.
[13] 宋希, 申玉英, 吴会玲, 等. 老年COPD患者衰弱情况调查及其与预后、再住院率的相关性研究[J]. 临床肺科杂志, 2021, 26(6):885-890.
[14] 杨妹, 吴燕丽, 邢柏. 老年脓毒症幸存者出院时老年营养风险指数与非计划再入院的相关性研究[J]. 现代预防医学, 2021, 48(21):3884-3888, 3910.

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