老年住院患者衰弱与估算肾小球滤过率降低对再住院风险的影响

Effects of frailty and decreased estimated glomerular filtration rate on re-hospitalization in elderly inpatients

摘要:

目的 探讨老年住院患者衰弱与估算肾小球滤过率(eGFR)降低对再住院风险的影响。方法 选取2015年7月至2016年12月期间在首都医科大学附属复兴医院综合科收治的年龄≥65岁的老年住院患者274例,采用衰弱表型(FP)评估衰弱情况,并据此将患者分为衰弱组、衰弱前期组和非衰弱组。收集患者一般临床资料、疾病史、共病数量、临床用药情况及生化检查,通过血肌酐(SCr)获得eGFR,根据eGFR水平将患者分为eGFR>60 ml/(min·1.73 m²)和eGFR≤60 ml/(min·1.73 m²)2组,对所有患者进行1年再住院情况随访。采用SPSS 18.0统计软件进行分析。根据数据类型,采用方差分析法或χ²检验比较组间差异,采用Cox回归分析衰弱与eGFR下降对再入院风险的影响。结果 274例患者中有非衰弱76例(27.7%)、衰弱前期114例(41.6%)、衰弱84例(30.6%)；与非衰弱组比较,衰弱前期及衰弱组患者eGFR水平偏低(P=0.018),年龄偏大、高血压、慢性阻塞性肺疾病(COPD)及eGFR≤60 ml/(min·1.73 m²)的比例增高(P<0.05),衰弱组共病数量(≥4)及服药品种数量(>5)最多。校正年龄、性别及共病数量后,与eGFR>60 ml/(min·1.73 m²)且无衰弱患者相比,同时存在衰弱和eGFR≤60 ml/(min·1.73 m²)的患者再住院风险增加(HR=2.40,5%CI 1.39~4.16)。结论 衰弱的老年住院患者eGFR水平偏低,eGFR降低伴有衰弱患者再住院率明显增加。

Abstract:

Objective To investigate the effects of frailty and decreased estimated glomerular filtration rate (eGFR) on re-hospitalization in the elderly inpatients. Methods A total of 274 elderly inpatients (aged ≥65 years) admitted in our department from July 2015 to December 2016 were prospectively recruited in this study. Their status of frailty was evaluated with frailty phenotype (FP), and then they were assigned into the frail group, pre-frail group and non-frail group. Their general information and clinical data, medical history, comorbidity number, medication number and laboratory examination results were collected, and eGFR was calculated based on serum creatinine (SCr) level. The patients were also divided into eGFR >60 ml/(min·1.73 m²) group and ≤60 ml/(min·1.73 m²) group. All the patients were followed up for 1 year, and the endpoint event was re-hospitalization. SPSS statistics 18.0 was used to perform the statistical analysis. Analysis of variance or Chi-square test was employed for comparison on different data types. Cox regression analysis was adopted for the effects of frailty and decreased eGFR on re-hospitalization. ResultsOf the 274 patients, there were 76(27.7%) patients assigned into non-frail group, 114(41.6%) into pre-frail group, and 84(30.6%) into frail group. Compared with the non-frail group, the eGFR level was significantly lower (P=0.018), while the proportions of older age, hypertension, chronic obstructive pulmonary disease (COPD) and eGFR ≤60 ml/(min·1.73 m²) were obviously higher in the pre-frail and frail groups (P<0.05). What′s more, the frail group had largest numbers of comorbidities and of medications. After adjustment for age, sex and comorbidities, the patients with eGFR ≤60 ml/(min·1.73 m²) and frailty at the same time had an increased risk for re-hospitalization compared with those with eGFR >60 ml/(min·1.73 m²) and non-frailty (HR=2.40, 95%CI 1.39-4.16). Conclusion The frail elderly inpatients commonly have lower eGFR level, and those with decreased eGFR are prone to re-hospitalization.