Abstract：
Older adults are susceptible to anticholinergic effects. Dysphagia and pneumonia are associated with anticholinergic usage, though a definitive causative relationship has not been established. There is no effective way to predict the prognosis of older adults with pneumonia; therefore, this study investigates the predictive value of anticholinergic burden.
Patients aged 65 years and above admitted for community-acquired pneumonia from 2011 to 2018 in Denmark were included through Danish registries. We calculated anticholinergic drug exposure using the CRIDECO Anticholinergic Load Scale (CALS). The primary outcome was in-hospital mortality, and other outcomes included intensive care unit admission, ventilator usage, length of stay, 30-day/90-day/1-year mortality, institutionalisation, home care utilisation and readmission.
186,735 patients were included in the in-hospital outcome analyses, 165,181 in the readmission analysis, 150,791 in the institutionalisation analysis, and 95,197 and 73,461 patients in the home care analysis at follow-up. Higher CALS score was associated with higher in-hospital mortality, with a mean risk increasing from 9.9% (CALS 0) to 16.4% (CALS >10), though the risk plateaued above a CALS score of 8. A higher CALS score was also associated with greater mortality after discharge, more home health care, more institutionalizations and higher readmission rates.
High anticholinergic burden levels were associated with poor patient outcomes including short-/long-term mortality, dependence and readmission. It may be useful to calculate the CALS score on admission of older patients with pneumonia to predict their prognosis. This also highlights the importance of avoiding the use of drugs with a high anticholinergic burden in older patients.
Patients aged 65 years and above admitted for community-acquired pneumonia from 2011 to 2018 in Denmark were included through Danish registries. We calculated anticholinergic drug exposure using the CRIDECO Anticholinergic Load Scale (CALS). The primary outcome was in-hospital mortality, and other outcomes included intensive care unit admission, ventilator usage, length of stay, 30-day/90-day/1-year mortality, institutionalisation, home care utilisation and readmission.
186,735 patients were included in the in-hospital outcome analyses, 165,181 in the readmission analysis, 150,791 in the institutionalisation analysis, and 95,197 and 73,461 patients in the home care analysis at follow-up. Higher CALS score was associated with higher in-hospital mortality, with a mean risk increasing from 9.9% (CALS 0) to 16.4% (CALS >10), though the risk plateaued above a CALS score of 8. A higher CALS score was also associated with greater mortality after discharge, more home health care, more institutionalizations and higher readmission rates.
High anticholinergic burden levels were associated with poor patient outcomes including short-/long-term mortality, dependence and readmission. It may be useful to calculate the CALS score on admission of older patients with pneumonia to predict their prognosis. This also highlights the importance of avoiding the use of drugs with a high anticholinergic burden in older patients.
摘要：
背景：老年人对抗胆碱能作用敏感。吞咽困难和肺炎与抗胆碱能药物的使用有关，尽管尚未建立明确的因果关系。没有有效的方法来预测老年人肺炎的预后；因此，本研究探讨抗胆碱能负荷的预测价值.
方法：丹麦2011年至2018年因社区获得性肺炎入院的65岁及以上患者通过丹麦登记处纳入。我们使用CRIDECO抗胆碱能负荷量表（CALS）计算抗胆碱能药物暴露。主要结果是住院死亡率，其他结果包括重症监护病房入院，呼吸机的使用,逗留时间,30天/90天/1年死亡率，制度化,家庭护理利用和重新接纳。
结果：186,735例患者被纳入院内结局分析，165,181在再接纳分析中，150,791在制度化分析中，95,197和73,461名患者在家庭护理分析中随访。较高的CALS评分与较高的住院死亡率相关，平均风险从9.9%(CALS0)增加到16.4%(CALS>10)，尽管风险稳定在CALS得分为8分以上。较高的CALS评分也与出院后较高的死亡率相关，更多的家庭保健，更多的制度化和更高的再入院率。
结论：高抗胆碱能负荷水平与不良患者预后相关，包括短期/长期死亡率，依赖和重新接纳。计算老年肺炎患者入院时的CALS评分可能有助于预测其预后。这也突出了在老年患者中避免使用具有高抗胆碱能负担的药物的重要性。
方法：丹麦2011年至2018年因社区获得性肺炎入院的65岁及以上患者通过丹麦登记处纳入。我们使用CRIDECO抗胆碱能负荷量表（CALS）计算抗胆碱能药物暴露。主要结果是住院死亡率，其他结果包括重症监护病房入院，呼吸机的使用,逗留时间,30天/90天/1年死亡率，制度化,家庭护理利用和重新接纳。
结果：186,735例患者被纳入院内结局分析，165,181在再接纳分析中，150,791在制度化分析中，95,197和73,461名患者在家庭护理分析中随访。较高的CALS评分与较高的住院死亡率相关，平均风险从9.9%(CALS0)增加到16.4%(CALS>10)，尽管风险稳定在CALS得分为8分以上。较高的CALS评分也与出院后较高的死亡率相关，更多的家庭保健，更多的制度化和更高的再入院率。
结论：高抗胆碱能负荷水平与不良患者预后相关，包括短期/长期死亡率，依赖和重新接纳。计算老年肺炎患者入院时的CALS评分可能有助于预测其预后。这也突出了在老年患者中避免使用具有高抗胆碱能负担的药物的重要性。
