Inflammation and disability as risk factors for mortality in elderly acute care patients

被引:22
作者
Forasassi, Christine [1 ]
Golmard, Jean-Louis [2 ]
Pautas, Eric [3 ]
Piette, Francois [4 ]
Myara, Isaac [5 ]
Raynaud-Simon, Agathe [1 ]
机构
[1] Hop Charles Foix, Serv Gerontol 5, F-94205 Ivry, France
[2] Hop La Pitie Salpetriere, Dept Biostat, F-75013 Paris, France
[3] Hop Charles Foix, Serv Gerontol 4, F-94205 Ivry, France
[4] Hop Charles Foix, Serv Med Interne & Geriatrie, F-94205 Ivry, France
[5] Hop Charles Foix, Serv Biochim, F-94205 Ivry, France
关键词
Inflammation in elderly; Mortality in acute care settings; C-reactive protein; Orosomucoid in elderly subjects; C-REACTIVE PROTEIN; HOSPITALIZED MEDICAL PATIENTS; FUNCTIONAL STATUS; ENERGY UNDERNUTRITION; MYOCARDIAL-INFARCTION; OLDER PATIENTS; SERUM-ALBUMIN; PREDICTORS; INDEX; OUTCOMES;
D O I
10.1016/j.archger.2008.03.011
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
Although the role of inflammation has been studied in specific diseases or in community living elderly, data in hospitalized acute care elderly patients are scarce. The present study was designed to determine the predictive value of sociodemographic, clinical and biological factors for mortality in acute care geriatric wards. Retrospective study was conducted in two acute care wards in a university-based geriatric hospital with elderly patients (n = 224) consecutively admitted to acute care wards with available medical files. Sociodemographic variables, primary medical diagnosis and number of associated conditions. dementia, depression, pressure sores, functional status (measure by the activities of daily living = ADL scale), weight, and plasma levels of albumin, transthyretin, C-reactive protein (CRP) and orosomucoid were recorded at admission. Patients who died in the acute care wards were compared to those who survived. The mean length of stay was 16 +/- 13 days; mortality was 12%. Univariate analysis revealed that disability, no anti-depressant drug, pressure ulcers, a higher number of associated conditions. living with another person, and biological markers of malnutrition (albumin < 35 g/l, transthyretin < 200 mg/l) and inflammation (CRP <= 30 mg/l, orosomucoid >= 1.25 g/l) were significantly associated with an increase in the risk of death. The logistic regression model retained CRP >= 30 mg/l (odds ratio (OR) = 3.72, 95% confidence interval (CI) = 1.34-10.31; p = 0.009) and disability for at least one ADL item (OR = 2.16, 95% CI = 1.55-2.99; p < 0.001) as independent risk factors for death. We conclude that CRP and disability are strong independent risk factors for death in this population, and special attention should be paid to these patients in an integrated therapeutic approach to geriatric care. (c) 2008 Elsevier Ireland Ltd. All rights reserved.
引用
收藏
页码:406 / 410
页数:5
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