Five-Year Risk of Mechanical Ventilation in Community-Dwelling Adults: The Framingham–Intermountain Anticipating Life Support Study

• Autores: Allan J. Walkey, Karol M. Pencina, Daniel Knox, Kathryn G. Kuttler, Ralph B. D'Agostino, Emelia J. Benjamin, Samuel M. Brown
• Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 63, Nº. 10, 2015, págs. 2082-2088
• Idioma: inglés
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• Resumen

  • Objectives To develop a quantitative tool for identifying outpatients most likely to require life support with mechanical ventilation within 5 years.

    Design Retrospective cohort study.

    Setting Framingham Heart Study (FHS) 1991 to 2009 and Intermountain Healthcare clinics 2008 to 2013.

    Participants FHS participants (n = 3,666; mean age 74; 58% female) in a derivation cohort and Intermountain Healthcare outpatients aged 65 and older (n = 88,302; mean age 73, 57% female) in an external validation cohort.

    Measurements Information on demographic characteristics and comorbidities collected during FHS examinations to derive a 5-year risk score for receiving mechanical ventilation in an intensive care unit, with external validation using administrative data from outpatients seen at Intermountain Healthcare. A sensitivity analysis investigating model performance for a composite outcome of mechanical ventilation or death was performed.

    Results Eighty (2%) FHS participants were mechanically ventilated within 5 years after a FHS examination. Age, sex, diabetes mellitus, hypertension, atrial fibrillation, alcohol use, chronic pulmonary disease, and hospitalization within the prior year predicted need for mechanical ventilation within 5 years (c-statistic = 0.74, 95% confidence interval (CI) = 0.68–0.80). One thousand seven hundred twenty-five (2%) Intermountain Healthcare outpatients underwent mechanical ventilation. The validation model c-statistic was 0.67 (95% CI = 0.66–0.68). Approximately 1% of individuals identified as low risk and 5% to 12% identified as high risk required mechanical ventilation within 5 years. Sensitivity analysis demonstrated a c-statistic of 0.75 (95% CI = 0.75–0.75) for risk prediction of a composite outcome of mechanical ventilation or death.

    Conclusion A simple risk score using clinical examination data or administrative data may be used to predict 5-year risk of mechanical ventilation or death. Further study is necessary to determine whether use of a risk score enhances advance care planning or improves quality of care of older adults.