A Multidimensional Risk Score to Predict All-Cause Hospitalization in Community-Dwelling Older Individuals With Obstructive Lung Disease

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• 作者：Rosanne J.H.C.G. Beijers ; MSc^a ; Bram van den Borst ; MD ; PhD^a ; ^{b.vdborst@maastrichtuniversity.nl" class="auth_mail" title="E-mail the corresponding author} ; Anne B. Newman ; MD^b ; Sachin Yende ; MD^c ; ^d ; Stephen B. Kritchevsky ; PhD^e ; Patricia A. Cassano ; PhD^f ; ^g ; Douglas C. Bauer ; MD^h ; Tamara B. Harris ; MDⁱ ; Annemie M.W.J. Schols ; PhD^a ; for the Health ABC Study
• 关键词：COPD ; pulmonary disease ; older age persons ; Cox proportional hazards modeling
• 刊名：Journal of the American Medical Directors Association
• 出版年：2016
• 出版时间：1 June 2016
• 年：2016
• 卷：17
• 期：6
• 页码：508-513
• 全文大小：325 K

文摘

Both respiratory and nonrespiratory hospitalizations are common and costly events in older individuals with obstructive lung disease. Prevention of any hospitalization in these individuals is essential. We aimed to construct a prediction model for all-cause hospitalization risk in community-dwelling older individuals with obstructive lung disease.

bsSec_2">Methods

bspara0015">We studied 268 community-dwelling individuals with obstructive lung disease (defined as FEVb>1b>/FVC<LLN) who participated in the observational Health, Aging, and Body Composition Study and constructed a prediction model for 9-year all-cause hospitalization risk using a weighted linear combination based on beta coefficients.

bsSec_3">Results

bspara0020">There were 225 individuals with 1 or more hospitalizations and 43 individuals free from hospitalization during the follow-up. Heart and vascular disease (H), objectively measured lower extremity dysfunction (O), systemic inflammation (S), dyspnea (P), impaired renal function (I), and tobacco exposure (T) were independent predictors for all-cause hospitalization (ALL). These factors were combined into the HOSPITALL score (0–23 points), with an area under the curve in ROC analysis of 0.70 (P < .001). The hazard ratio for all-cause hospitalization per 1-point increase in the HOSPITALL score was 1.15 (95% confidence interval, 1.11–1.19, P = .001). Increasing HOSPITALL score was further associated with shorter time to first admission, increased admission rate, and more respiratory admissions.

bsSec_4">Conclusion

bspara0025">The HOSPITALL score is a multidimensional score to predict all-cause hospitalization risk in community-dwelling older individuals with obstructive lung disease that may aid in patient counseling and prevention to reduce burden and health care costs.