某医院老年住院患者疾病累及系统数及死亡风险评估

目的探讨老年住院患者疾病累及系统数的情况及其对死亡的影响。方法参照疾病和有关健康问题的国际统计分类ICD-10对广东省某医院老年住院患者疾病所属系统进行归类统计,并采用logistic回归分析疾病累及系统数对死亡的影响,采用ROC曲线分析疾病累及系统数对死亡的预测价值。结果老年住院患者疾病累及系统数2个及以上占比76.80%,疾病累及系统数4个及以上占比30.05%。男性老年患者疾病累及5个及以上系统的比例(20.87%)高于女性(15.30%,P<0.05)。疾病累及系统数越多,老年住院患者死亡的风险越大(OR=1.471)。校正年龄、性别、住院天数、有无转科、入院途径、病人来源、是否手术、有无合并手术、病例分型等因素的影响后,疾病累及系统数每增加1个,老年住院患者发生死亡的风险增加21.00%。疾病累及系统数对老年住院患者死亡有一定的预测价值,ROC曲线下面积为0.734(95%CI:0.711~0.758)。结论疾病累及系统数是老年住院患者死亡的危险因素,建议密切关注老年住院患者疾病累及系统数的情况,建立多学科共诊的诊疗模式,维护老年人口的健康状况。

Number of disease-related systems and its risk assessment on death for old inpatients in a hospital

Objective To investigate the number of disease-involved systems of elders and its influence on death for inpatients.Methods According to the international statistical classification of diseases and related health problems(ICD-10),the disease-involved systems of elderly inpatients in a hospital in Guangdong Province were classified.Logistic regression was used to analyze the influence of number of disease-involved systems on death and roc curve was used to analyze its predictive value for the death of inpatients.Results The proportion of diseases involving two or more systems and four or more systems in the hospitalized elders were 76.80%and 30.05%respectively.The proportion of diseases involving 5 or more systems was 20.87%in males,which was statistically higher than that in females(15.30%)(P<0.05).The more number of disease-related systems,the greater the risk of death for older patients(OR=1.471).After adjusting for the effects of age,sex,hospitalization days,transfer section,route of admission,source of patient,operation,combined operation,and case classification,the risk of death for patients would increase 21.00%when number of disease-related systems added one.Number of disease-involved systems had certain predictive value for death of elders in the hospital,with area under roc curve was 0.734(95%CI:0.711-0.758).Conclusion Number of disease-related systems was an independent risk factor for hospitalized elders(≥60 years),which suggested that close attention to the number of disease-related systems should be paid and multi-disciplinary co-diagnosis and treatment model needed to be established in order to maintain the health status of elders.