Abstract：
Increasing number of older adults with Plasma Cell Disorders (PCDs) are receiving autologous stem cell transplant (ASCT) in the US. Hospital associated disability (HAD) is a common complication associated with acute care hospitalization among older adults. To estimate the prevalence and prognostic significance of HAD among older adults with MM undergoing ASCT. This retrospective cohort study used consecutive adults ≥ 18 y with PCD receiving ASCT at a single institution between 1/2013 and 5/2023. Trained nursing staff assessed Katz Activities of Daily Living (ADL) at admission and every 3 days thereafter under our Virtual Acute Care for Elders program. The primary outcome was development of HAD defined as ≥1 point decline on the Katz Activities of Daily Living (ADL) scale from hospital admission to discharge. We examined the association between putative risk factors such as age, Karnofsky performance status (KPS), baseline ADL score, Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI) and HAD using modified Poisson regression models with robust variance estimators. Subsequently, we studied the impact of HAD on downstream adverse events including 30-day readmission rates and long term survival. We included 778 adults with a median age of 62 y (QR 56-68 y), with 56% males and 55% non-Hispanic Whites. In the overall population, 112 (14.4%) developed HAD, with much higher incidence among older adults ≥ 65 y compared to those <65 y at ASCT (22% vs. 9%, P value < .01). In multivariable analysis, increasing age (RR 1.56; 95% CI 1.25-1.94, per 10 y increase), female sex (RR 1.79; 95% CI 1.27-2.53) and KPS ≤ 70 (RR 2.55; 95% CI 1.32-4.94) were associated with an increased risk of developing HAD. As compared to those without, patients with HAD had a two-fold higher risk of 30-day readmission (95% CI 1.16-3.39) and a 3.7-fold increased risk of all-cause mortality (95% CI 2.15-6.22). Nearly one in 4 older adults ≥ 65 y developed HAD while undergoing ASCT which was associated with a two-fold increased risk of 30-day readmission. Interventions to prevent HAD and its downstream consequences are critically needed.
摘要：
背景：在美国，越来越多的患有浆细胞疾病（PCD）的老年人正在接受自体干细胞移植（ASCT）。医院相关残疾（HAD）是老年人中与急性护理住院相关的常见并发症。
目的：评估接受ASCT的老年MM患者中HAD的患病率和预后意义研究设计：：这项回顾性队列研究使用2013年1月至2023年5月1日期间在单一机构接受ASCT的≥18yPCD的连续成年人。训练有素的护理人员在入院时以及之后每3天根据我们的老年人虚拟急性护理计划评估Katz日常生活活动（ADL）。主要结果是HAD的发展，定义为从入院到出院的Katz日常生活活动（ADL）量表下降≥1点。我们检查了推定的风险因素之间的关联，如年龄，Karnofsky性能状态（KPS），基线ADL评分,造血细胞移植特异性合并症指数(HCT-CI)和HAD使用具有稳健方差估计的改良泊松回归模型。随后，我们研究了HAD对下游不良事件的影响,包括30日再入院率和长期生存率.
结果：我们包括778名成年人，中位年龄为62岁（QR56-68岁），56%的男性和55%的非西班牙裔白人。在总人口中,112（14.4%）发展为HAD，与ASCT时<65y的老年人相比，≥65y的发病率要高得多(22%与9%,p值<0.01)。在多变量分析中，年龄增加(RR1.56；95%CI1.25-1.94，每增加10年)，女性(RR1.79;95%CI1.27~2.53)和KPS≤70(RR2.55;95%CI1.32~4.94)与发生HAD的风险增加相关.与没有的人相比，HAD患者30日再入院风险增加2倍(95%CI1.16~3.39),全因死亡风险增加3.7倍(95%CI2.15~6.22).
结论：近四分之一≥65岁的老年人在接受ASCT时发生HAD，这与30天再入院风险增加两倍相关。迫切需要采取干预措施来预防HAD及其下游后果。
目的：评估接受ASCT的老年MM患者中HAD的患病率和预后意义研究设计：：这项回顾性队列研究使用2013年1月至2023年5月1日期间在单一机构接受ASCT的≥18yPCD的连续成年人。训练有素的护理人员在入院时以及之后每3天根据我们的老年人虚拟急性护理计划评估Katz日常生活活动（ADL）。主要结果是HAD的发展，定义为从入院到出院的Katz日常生活活动（ADL）量表下降≥1点。我们检查了推定的风险因素之间的关联，如年龄，Karnofsky性能状态（KPS），基线ADL评分,造血细胞移植特异性合并症指数(HCT-CI)和HAD使用具有稳健方差估计的改良泊松回归模型。随后，我们研究了HAD对下游不良事件的影响,包括30日再入院率和长期生存率.
结果：我们包括778名成年人，中位年龄为62岁（QR56-68岁），56%的男性和55%的非西班牙裔白人。在总人口中,112（14.4%）发展为HAD，与ASCT时<65y的老年人相比，≥65y的发病率要高得多(22%与9%,p值<0.01)。在多变量分析中，年龄增加(RR1.56；95%CI1.25-1.94，每增加10年)，女性(RR1.79;95%CI1.27~2.53)和KPS≤70(RR2.55;95%CI1.32~4.94)与发生HAD的风险增加相关.与没有的人相比，HAD患者30日再入院风险增加2倍(95%CI1.16~3.39),全因死亡风险增加3.7倍(95%CI2.15~6.22).
结论：近四分之一≥65岁的老年人在接受ASCT时发生HAD，这与30天再入院风险增加两倍相关。迫切需要采取干预措施来预防HAD及其下游后果。
