Originales
Análisis de mortalidad tras el ingreso en una unidad de agudos de geriatría: influencia de la dependencia funcional1
Analysis of mortality after admission to an acute geriatric unit: influence of functional dependency
Miriam Rosa Ramos Cortés
, Elena Romero Pisonero, Jesús Mora Fernández, Luis José Silveira Guijarro, José Manuel Ribera Casado
Autor para correspondencia
miroracor@hotmail.com
Correspondencia: Dra. M.R. Ramos Cortés. Servicio de Geriatría. Hospital Clínico San Carlos. Prof. Martín Lagos, s/n. 28040 Madrid. España.
Correspondencia: Dra. M.R. Ramos Cortés. Servicio de Geriatría. Hospital Clínico San Carlos. Prof. Martín Lagos, s/n. 28040 Madrid. España.
Servicio de Geriatría. Hospital Clínico San Carlos. Madrid. España
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Pedro Manuel Sánchez Jurado, Carmen Luengo Márquez, Laura Domínguez Martín, Vicente Lozano Berrio" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Pedro" "apellidos" => "Abizanda Soler" ] 1 => array:2 [ "nombre" => "Matilde" "apellidos" => "León Ortiz" ] 2 => array:2 [ "nombre" => "Luis" "apellidos" => "Romero Rizos" ] 3 => array:2 [ "nombre" => "Pedro Manuel" "apellidos" => "Sánchez Jurado" ] 4 => array:2 [ "nombre" => "Carmen" "apellidos" => "Luengo Márquez" ] 5 => array:2 [ "nombre" => "Laura" "apellidos" => "Domínguez Martín" ] 6 => array:2 [ "nombre" => "Vicente" "apellidos" => "Lozano Berrio" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211139X07735527?idApp=UINPBA00004N" "url" => "/0211139X/0000004200000004/v1_201305031835/S0211139X07735527/v1_201305031835/es/main.assets" ] "es" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Originales</span>" "titulo" => "Análisis de mortalidad tras el ingreso en una unidad de agudos de geriatría: influencia de la dependencia funcional<a class="elsevierStyleCrossRef" href="#fn1"><span class="elsevierStyleSup">1</span></a>" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "212" "paginaFinal" => "217" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Miriam Rosa Ramos Cortés, Elena Romero Pisonero, Jesús Mora Fernández, Luis José Silveira Guijarro, José Manuel Ribera Casado" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Miriam Rosa" "apellidos" => "Ramos Cortés" "email" => array:1 [ 0 => "miroracor@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor1" ] ] ] 1 => array:2 [ "nombre" => "Elena" "apellidos" => "Romero Pisonero" ] 2 => array:2 [ "nombre" => "Jesús" "apellidos" => "Mora Fernández" ] 3 => array:2 [ "nombre" => "Luis José" "apellidos" => "Silveira Guijarro" ] 4 => array:2 [ "nombre" => "José Manuel" "apellidos" => "Ribera Casado" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Geriatría. Hospital Clínico San Carlos. Madrid. España" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Correspondencia: Dra. M.R. Ramos Cortés. Servicio de Geriatría. Hospital Clínico San Carlos. Prof. Martín Lagos, s/n. 28040 Madrid. España." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Analysis of mortality after admission to an acute geriatric unit: influence of functional dependency" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2007-04-03" "fechaAceptado" => "2007-06-18" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec104244" "palabras" => array:4 [ 0 => "Unidades de agudos de geriatría" 1 => "Análisis de supervivencia" 2 => "Mortalidad" 3 => "Ancianos en riesgo" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec104245" "palabras" => array:4 [ 0 => "Acute geriatric units" 1 => "Survival analysis" 2 => "Mortality" 3 => "Frail elderly" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Analizar la influencia de diversos factores clínicos y funcionales en la tasa de mortalidad anual tras ingreso en unidad de agudos de geriatría (UGA).</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p class="elsevierStyleSimplePara elsevierViewall">Pacientes ingresados durante 6 meses en la UGA. Se excluyeron los ingresos inadecuados o trasladados a otro servicio en el primer día. Para la valoración clínica, funcional y psíquica basal se utilizaron los índices de Katz y de Barthel, la escala de la Cruz Roja física y la presencia de demencia. Los datos al ingreso: mortalidad, complicaciones, impacto funcional del ingreso. En el seguimiento al año se analizaron los datos de mortalidad cruda y comorbilidad (índice de Charlson [ICh]). Se analizó la influencia de los datos basales y del ingreso en la supervivencia. El análisis estadístico se realizó mediante la comparación de medias y proporciones mediante las pruebas de la χ<span class="elsevierStyleSup">2</span>, de la t de Studenty ANOVA de un factor. El estudio de supervivencia se realizó mediante curvas de Kaplan-Meier y regresión de Cox, con un intervalo de confianza del 95%. Se utilizó el programa SPSS 1 1.0 para el procesamiento estadístico de los datos.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Se analizó a 336 pacientes, con una edad media ± desviación estándar de 85,6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6,9 años; el 59,2% eran mujeres. El grupo relacionado de diagnóstico principal fue de 541. Datos basales: demencia moderada o grave, 39,3%; dependencia en más de 3 actividades básicas, 45,4%; movilidad restringida, 48,2%, e incontinencia funcional, 29,9%. Datos del ingreso: impacto funcional, 19,5%, e infección nosocomial, 47,6%. La mortalidad intrahospitalaria fue del 22,9%. Durante el seguimiento hubo un 5,1% de pérdidas. Al año fallecieron 107 pacientes más (total 1 84; 54,8%). La mitad de los fallecimientos se produjo en los primeros 59 días contados desde el día del ingreso. Mediana de supervivencia, 275 días. Comorbilidad ICh > 2 (47,6%). Las causas de defunción fueron: en el 37,5% de los casos, respiratoria, y en el 31,0% de los pacientes, circulatoria. Los factores relacionados con la mortalidad fueron: sexo varón (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,029), demencia (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,002), pérdida funcional (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001), infección respiratoria nosocomial (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,026), cuadro confusional (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001) y comorbilidad (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,015); no se encontró asociación con la edad u otros factores clínicos. En el modelo de regresión de Cox, únicamente servarón (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,021) y la pérdida funcional asociada al ingreso (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001) se asociaron a mortalidad en el seguimiento.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Se observó una elevada mortalidad durante los primeros dos meses desde el ingreso hospitalario, sobre todo por afección respiratoria y circulatoria. Aunque el sexo se asocia con la mortalidad en el seguimiento, ésta depende en mayor medida de la situación funcional. Se hace necesario establecer estrategias preventivas o de intervención en determinados grupos de ancianos de riesgo en los que es previsible una elevada mortalidad.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">To analyze the influence of several clinical and functional factors on the annual mortality rate following admission to an acute geriatric unit (AGU).</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p class="elsevierStyleSimplePara elsevierViewall">Patients admitted to the AGU over a 6-month period were included. Inappropriate admissions and those transferred to another service within 24 hours were excluded. Clinical, functional and psychic evaluations (Katz index, Barthel index, Physical Red Cross scale, presence of dementia) were performed. Admission data: mortality, complications, functional impact of admission. Follow-up at 1 year: data on crude mortality and comorbidity (Charlson index). The influence of baseline data and of admission on survival was analyzed. The statistical analysis consisted of comparison of means and proportions through the chi-squared test, Student’s t-test and one-way ANOVA. Survival was studied through Kaplan-Meier curves and Cox regression. A 95% confidence interval was used. Data were analyzed with the SPSS 1 1.0 statistical package.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">There were 336 patients (mean age 85.6 years; SD 6.9); 59.2% were women. Main diagnosis-related group: 541. Baseline data: moderate or severe dementia was found in 39.3%, dependency for more than three basic activities of daily living in 45.4%, restricted mobility in 48.2%, and functional incontinence in 29.9%. Admission data: functional impact was found in 19.5% and nosocomial infection in 47.6%. In-hospital mortality: 22.9%. Follow-up: 5.1% were lost to follow-up. At 1 year a further 107 patients had died (total 184; 54.8%). Half of the deaths occurred in the first 59 days after admission. The median survival was 275 days. The Charlson comorbidity index score was >2: 47.6%. Causes of death were respiratory in 37.5% and circulatory in 31.0%. The factors related to mortality were male sex (<span class="elsevierStyleItalic">P</span>=.029), dementia (<span class="elsevierStyleItalic">P</span> =.002), functional loss (<span class="elsevierStyleItalic">P</span><.001), nosocomial respiratory infection (<span class="elsevierStyleItalic">P</span> =.026), confusional syndrome (<span class="elsevierStyleItalic">P</span><.001), and comorbidity (<span class="elsevierStyleItalic">P</span>=.015). No association was found with age or other clinical factors. In the Cox regression model, only male sex (<span class="elsevierStyleItalic">P</span>=.021) and functional loss associated with admission (<span class="elsevierStyleItalic">P</span><.001) were related to mortality during follow-up.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Mortality was high during the first 2 months after hospital admission, especially that due to respiratory and circulatory disease. Although sex was associated with mortality during follow-up, mortality was to a greater extent due to functional status. Preventive strategies and/or interventions are required in specific groups of elderly patients with an elevated risk of mortality.</p>" ] ] "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "1" "nota" => "<p class="elsevierStyleNotepara">Parte de los resultados de este trabajo fue presentada en el 48.° Congreso Nacional de Geriatría y Gerontología, Pamplona, 2006.</p>" "identificador" => "fn1" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Factores asociados al deterioro funcional al ingreso y al alta hospitalaria en ancianos ingresados por enfermedad aguda" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T. Alarcón" 1 => "J.I. González-Montalvo" 2 => "A. Bárcena" 3 => "A. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Octubre | 2 | 6 | 8 |
| 2024 Septiembre | 11 | 11 | 22 |
| 2024 Agosto | 14 | 3 | 17 |
| 2024 Julio | 11 | 10 | 21 |
| 2024 Junio | 5 | 5 | 10 |
| 2024 Mayo | 10 | 6 | 16 |
| 2024 Abril | 10 | 12 | 22 |
| 2024 Marzo | 12 | 19 | 31 |
| 2024 Febrero | 9 | 9 | 18 |
| 2024 Enero | 10 | 17 | 27 |
| 2023 Diciembre | 13 | 6 | 19 |
| 2023 Noviembre | 11 | 21 | 32 |
| 2023 Octubre | 23 | 50 | 73 |
| 2023 Septiembre | 15 | 22 | 37 |
| 2023 Agosto | 6 | 4 | 10 |
| 2023 Julio | 4 | 18 | 22 |
| 2023 Junio | 7 | 11 | 18 |
| 2023 Mayo | 11 | 14 | 25 |
| 2023 Abril | 4 | 4 | 8 |
| 2023 Marzo | 7 | 12 | 19 |
| 2023 Febrero | 13 | 10 | 23 |
| 2023 Enero | 8 | 5 | 13 |
| 2022 Diciembre | 8 | 4 | 12 |
| 2022 Noviembre | 16 | 10 | 26 |
| 2022 Octubre | 19 | 11 | 30 |
| 2022 Septiembre | 13 | 25 | 38 |
| 2022 Agosto | 12 | 17 | 29 |
| 2022 Julio | 10 | 8 | 18 |
| 2022 Junio | 43 | 11 | 54 |
| 2022 Mayo | 19 | 11 | 30 |
| 2022 Abril | 22 | 11 | 33 |
| 2022 Marzo | 17 | 5 | 22 |
| 2022 Febrero | 31 | 6 | 37 |
| 2022 Enero | 15 | 19 | 34 |
| 2021 Diciembre | 26 | 8 | 34 |
| 2021 Noviembre | 23 | 18 | 41 |
| 2021 Octubre | 24 | 23 | 47 |
| 2021 Septiembre | 20 | 12 | 32 |
| 2021 Agosto | 11 | 10 | 21 |
| 2021 Julio | 13 | 27 | 40 |
| 2021 Junio | 8 | 12 | 20 |
| 2021 Mayo | 10 | 7 | 17 |
| 2021 Abril | 21 | 28 | 49 |
| 2021 Marzo | 8 | 11 | 19 |
| 2021 Febrero | 5 | 7 | 12 |
| 2021 Enero | 13 | 8 | 21 |
| 2020 Diciembre | 8 | 10 | 18 |
| 2020 Noviembre | 13 | 10 | 23 |
| 2020 Octubre | 9 | 4 | 13 |
| 2020 Septiembre | 12 | 10 | 22 |
| 2020 Agosto | 11 | 12 | 23 |
| 2020 Julio | 15 | 12 | 27 |
| 2020 Junio | 14 | 4 | 18 |
| 2020 Mayo | 9 | 14 | 23 |
| 2020 Abril | 11 | 2 | 13 |
| 2020 Marzo | 19 | 9 | 28 |
| 2020 Febrero | 9 | 12 | 21 |
| 2020 Enero | 15 | 15 | 30 |
| 2019 Diciembre | 21 | 22 | 43 |
| 2019 Noviembre | 9 | 9 | 18 |
| 2019 Octubre | 7 | 10 | 17 |
| 2019 Septiembre | 8 | 12 | 20 |
| 2019 Agosto | 6 | 10 | 16 |
| 2019 Julio | 21 | 16 | 37 |
| 2019 Junio | 35 | 51 | 86 |
| 2019 Mayo | 120 | 133 | 253 |
| 2019 Abril | 43 | 37 | 80 |
| 2019 Marzo | 8 | 13 | 21 |
| 2019 Febrero | 5 | 11 | 16 |
| 2019 Enero | 14 | 7 | 21 |
| 2018 Diciembre | 10 | 9 | 19 |
| 2018 Noviembre | 6 | 13 | 19 |
| 2018 Octubre | 22 | 21 | 43 |
| 2018 Septiembre | 6 | 5 | 11 |
| 2018 Agosto | 7 | 5 | 12 |
| 2018 Julio | 11 | 11 | 22 |
| 2018 Junio | 10 | 7 | 17 |
| 2018 Mayo | 7 | 16 | 23 |
| 2018 Abril | 1 | 5 | 6 |
| 2018 Marzo | 4 | 8 | 12 |
| 2018 Febrero | 7 | 4 | 11 |
| 2018 Enero | 5 | 1 | 6 |
| 2017 Diciembre | 6 | 1 | 7 |
| 2017 Noviembre | 5 | 4 | 9 |
| 2017 Octubre | 11 | 1 | 12 |
| 2017 Septiembre | 7 | 5 | 12 |
| 2017 Agosto | 7 | 2 | 9 |
| 2017 Julio | 3 | 0 | 3 |
| 2017 Junio | 11 | 11 | 22 |
| 2017 Mayo | 11 | 1 | 12 |
| 2017 Abril | 9 | 0 | 9 |
| 2017 Marzo | 20 | 11 | 31 |
| 2017 Febrero | 7 | 1 | 8 |
| 2017 Enero | 8 | 0 | 8 |
| 2016 Diciembre | 28 | 5 | 33 |
| 2016 Noviembre | 33 | 0 | 33 |
| 2016 Octubre | 64 | 4 | 68 |
| 2016 Septiembre | 9 | 6 | 15 |
| 2016 Agosto | 3 | 1 | 4 |
| 2016 Julio | 12 | 1 | 13 |
| 2016 Junio | 22 | 3 | 25 |
| 2016 Mayo | 35 | 8 | 43 |
| 2016 Abril | 29 | 1 | 30 |
| 2016 Marzo | 27 | 3 | 30 |
| 2016 Febrero | 21 | 2 | 23 |
| 2016 Enero | 22 | 3 | 25 |
| 2015 Diciembre | 40 | 3 | 43 |
| 2015 Noviembre | 25 | 8 | 33 |
| 2015 Octubre | 33 | 8 | 41 |
| 2015 Septiembre | 36 | 12 | 48 |
| 2015 Agosto | 56 | 3 | 59 |
| 2015 Julio | 41 | 7 | 48 |
| 2015 Junio | 27 | 6 | 33 |
| 2015 Mayo | 45 | 5 | 50 |
| 2015 Abril | 34 | 11 | 45 |
| 2015 Marzo | 41 | 2 | 43 |
| 2015 Febrero | 26 | 5 | 31 |
| 2015 Enero | 31 | 3 | 34 |
| 2014 Diciembre | 36 | 5 | 41 |
| 2014 Noviembre | 41 | 2 | 43 |
| 2014 Octubre | 47 | 1 | 48 |
| 2014 Septiembre | 30 | 2 | 32 |
| 2014 Agosto | 32 | 4 | 36 |
| 2014 Julio | 36 | 1 | 37 |
| 2014 Junio | 56 | 1 | 57 |
| 2014 Mayo | 36 | 3 | 39 |
| 2014 Abril | 21 | 7 | 28 |
| 2014 Marzo | 28 | 1 | 29 |
| 2014 Febrero | 30 | 8 | 38 |
| 2014 Enero | 17 | 8 | 25 |
| 2013 Diciembre | 29 | 2 | 31 |
| 2013 Noviembre | 27 | 4 | 31 |
| 2013 Octubre | 19 | 2 | 21 |
| 2013 Septiembre | 19 | 3 | 22 |
| 2013 Agosto | 16 | 1 | 17 |
| 2013 Julio | 6 | 0 | 6 |
| 2007 Junio | 779 | 0 | 779 |
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