Tasa de filtración glomerular estimada y mortalidad posterior al alta en una unidad geriátrica de agudos / Estimated glomerular filtration rate and post-hospital mortality after discharge from an acute care for the elderly unit

Objetivo: Determinar la asociación entre tasa de filtración glomerular estimada (TFGe) y mortalidad en una cohorte retrospectiva de adultos mayores hospitalizados en una unidad geriátrica de agudos (UGA). Materiales y métodos: Se incluyó a 1.678 pacientes de 60 años o más, en Cali, Colombia, de 2012 a 2015, en seguimiento hasta 2016. El desenlace primario fue mortalidad. La función renal se estimó empleando la ecuación del Modification of Diet in Renal Disease Study (MDRD-4). Se agrupó la función renal según la TFGe (ml/min/1,73m2) así: levemente disminuida (≥60), moderadamente disminuida (30-59) y severamente disminuida (<30). Se hicieron análisis de sobrevida bivariados y regresión de Cox multivariado. Resultados: En el análisis univariado, los pacientes con TFGe severamente disminuida presentaron una mortalidad significativamente mayor que aquellos con TFGe superiores (p=0,046). En el grupo con MDRD severamente disminuida, la sobrevida fue menor en el grupo dependiente (índice de Barthel [IB]<60) que en el independiente (IB≥60) (prueba log rank p=0,001). En el análisis multivariado, hay un aumento significativo del riesgo de morir en ancianos con MDRD severamente disminuida (<30) comparado con MDRD levemente disminuida (≥60) (hazard ratio [HR] 1,44; intervalo confianza [IC] 95%: 1,02-2,05; p=0,039). También hubo aumento significativo del riesgo de morir en ancianos dependientes comparados con los independientes (HR 1,72; IC 95%: 1,26-2,34; p=0,000), los que tenían a la vez morbilidad alta (≥4) con albúmina baja (<3,2g/dl) comparados con aquellos con morbilidad baja (0-3) y albúmina alta (≥3,2) (HR 1,77; IC 95%: 1,18-2,65; p=0,005) y en aquellos con PCR alta (16-102mg/dl) comparados con aquellos con PCR baja (0-15) (HR 1,42; IC 95%: 1,01-2,01; p=0,043). Conclusiones: El riesgo de mortalidad tiempo después de una hospitalización en una UGA es mayor en pacientes con TFGe<30. Las puntuaciones bajas en los índices del estado funcional, la comorbilidad alta, la hipoalbuminemia y los marcadores de inflamación son factores pronósticos adicionales a tener en cuenta. La mejoría en el estado funcional podría mejorar la sobrevida posterior a la hospitalización

Objective: To determine the relationship between estimated glomerular filtration rate (eGFR) and mortality in a retrospective cohort of older adults admitted to an acute care for the elderly (ACE) unit. Materials and methods: The study included 1,678 patients aged 60 years and over admitted to an AEC, in Cali, Colombia, from 2012 to 2015, and followed- up until 2016. The primary outcome was mortality. Renal function (eGFR) was estimated using Modification of Diet in Renal Disease Study (MDRD-4) equation. The renal function was grouped according to the eGFR (ml/min/1.73m2) as follows: slightly decreased (≥60), moderately decreased (30-59), and severely decreased (<30). Bivariate survival and multivariate Cox regression analyses were performed. Results: In the univariate analysis, patients with severely decreased eGFR had higher mortality than those with a higher eGFR (P=.046). In the group with severely decreased eGFR, survival was lower in the functionally dependent group (Barthel index [IB]<60) than in the independent group (IB≥60) (log rank test; P=.001). In the multivariate analysis, there was a significant increase in the risk of death in the elderly with severely decreased eGFR (<30) compared with slightly decreased eGFR (≥60) (hazard ratio [HR], 1.44; 95% confidence interval [CI]; 1.02-2.05, P=.039). There was also a significant increase in the risk of death in the dependent elderly compared to the independent ones [HR 1.72; 95% CI; 1.26-2.34, P=.000], those who had the high morbidity (≥4) with low albumin (<3.2g/dL) compared with those with low morbidity (0-3) and high albumin (≥3.2) [HR 1.77; 95% CI; 1.18-2.65, P=.005], and in those with a high (16-102mg/dL) C-reactive protein (CRP) compared with those with low CRP (0-15) [HR 1.42; 95% CI; 1.01-2.01, P=.043]. Conclusions: The risk of mortality after hospital admission to an AEC unit is greater in patients with eGFR<30. Poor functional status performance, high comorbidity, low plasma albumin, and increased inflammation markers are additional prognostic factors to be taken into account. The improvement in the functional status could improve the survival after hospitalisation

[Estimated glomerular filtration rate and post-hospital mortality after discharge from an acute care for the elderly unit]. / Tasa de filtración glomerular estimada y mortalidad posterior al alta en una unidad geriátrica de agudos.

OBJECTIVE: To determine the relationship between estimated glomerular filtration rate (eGFR) and mortality in a retrospective cohort of older adults admitted to an acute care for the elderly (ACE) unit. MATERIALS AND METHODS: The study included 1,678 patients aged 60 years and over admitted to an AEC, in Cali, Colombia, from 2012 to 2015, and followed- up until 2016. The primary outcome was mortality. Renal function (eGFR) was estimated using Modification of Diet in Renal Disease Study (MDRD-4) equation. The renal function was grouped according to the eGFR (ml/min/1.73m2) as follows: slightly decreased (≥60), moderately decreased (30-59), and severely decreased (<30). Bivariate survival and multivariate Cox regression analyses were performed. RESULTS: In the univariate analysis, patients with severely decreased eGFR had higher mortality than those with a higher eGFR (P=.046). In the group with severely decreased eGFR, survival was lower in the functionally dependent group (Barthel index [IB]<60) than in the independent group (IB≥60) (log rank test; P=.001). In the multivariate analysis, there was a significant increase in the risk of death in the elderly with severely decreased eGFR (<30) compared with slightly decreased eGFR (≥60) (hazard ratio [HR], 1.44; 95% confidence interval [CI]; 1.02-2.05, P=.039). There was also a significant increase in the risk of death in the dependent elderly compared to the independent ones [HR 1.72; 95% CI; 1.26-2.34, P=.000], those who had the high morbidity (≥4) with low albumin (<3.2g/dL) compared with those with low morbidity (0-3) and high albumin (≥3.2) [HR 1.77; 95% CI; 1.18-2.65, P=.005], and in those with a high (16-102mg/dL) C-reactive protein (CRP) compared with those with low CRP (0-15) [HR 1.42; 95% CI; 1.01-2.01, P=.043]. CONCLUSIONS: The risk of mortality after hospital admission to an AEC unit is greater in patients with eGFR<30. Poor functional status performance, high comorbidity, low plasma albumin, and increased inflammation markers are additional prognostic factors to be taken into account. The improvement in the functional status could improve the survival after hospitalisation.