摘要
目的应用累积缺陷衰弱指数(FI-CD)、衰弱表型评估(FP)、衰弱量表(FS)及临床衰弱量表(CFS)4种衰弱评估工具对老年住院患者进行衰弱评估,并对其预测老年住院患者出院后全因死亡的能力进行比较。方法采用队列研究方法,使用FI-CD、FP、FS和CFS分别进行衰弱评估。出院后随访≥3个月,死亡为观察终点,采用Cox回归模型评价不同衰弱评估工具评估结果与死亡结局之间的关系,受试者工作曲线(ROC)比较4种衰弱评估方法对死亡的预测效果。结果入选≥65岁老年住院患者630例,14例失访,平均随访时间24.8个月。采用FI-CD、FP、FS及CFS评估检出衰弱的比例分别为31.7%(195/616)、33.8%(208/616)、23.5%(145/616)和23.5%(145/616),死亡90例(14.6%)。在Cox回归模型中,校正年龄、性别等变量后,评估为衰弱的老年患者与非衰弱患者比较,出院后死亡风险增加(HR=5.78、6.21、2.16及5.61,95%CI 2.40~13.90,2.18~17.68,1.12~4.17及3.11~10.11,均P<0.05)。FI-CD、FP和CFS评估为衰弱前期的患者在调整年龄、性别情况后,与死亡结局仍相关,差异有统计学意义(HR=2.96、3.93及2.58,95%CI 1.22~7.22、1.38~11.14及1.36~4.92,P=0.017、0.010及0.004)。4种衰弱评估工具对死亡的预测:FI-CD、FP、FS及CFS预测死亡的ROC曲线下面积(AUC)分别为0.726、0.684、0.621和0.750(均P<0.001)。结论评估衰弱的发生率范围从23.5%(FS、CFS)到33.8%(FP)。衰弱为死亡的危险因素。FI-CD及CFS对老年住院患者的死亡有预测效果,其中CFS预测效果优于其他3种评估方法。
Objective To compare the frailty index of accumulative deficits(FI-CD),frailty phenotype(FP),frailty scale(FS),and clinical frailty scale(CFS)in evaluating frailty in the elderly inpatients and predicting their all-cause mortality after discharge from hospital.Methods In a cohort study,FI-CD,FP,FS,and CFS were used for frailty assessment.The subjects were followed up for over 3 months after discharge with death denoted as the observation endpoint.The Cox regression model was employed for assessing the relationships between frailty identified by different assessment methods and all-cause mortality,and the receiver operating characteristic(ROC)curve for comparing their predictive ability of death.Results Totally,630 patients aged≥65 years were recruited in the present study,of whom 14 were lost to follow-up.The average follow-up time was 24.8 months.The frailty evaluated by FI-CD,FP,FS and CFS were 31.7%,33.8%,23.5%and 23.5%,respectively,with 90 deaths(14.6%).In the Cox regression model adjusted for age,sex and other variables,FI-CD,FP,FS and CFS identified an increased risk of death after discharge in the frail patients against non-frail patients(HR=5.78,6.21,2.16 and 5.61;95%CI 2.40-13.90,2.18-17.68,1.12-4.17 and 3.11-10.11 respectively,all P<0.05).After adjustment for age and sex,pre-frailty as determined by FI-CD,FP and CFS was significantly associated with the increased risk of death(HR=2.96,3.93 and 2.58;95%CI 1.22-7.22,1.38-11.14 and 1.36-4.92,P=0.017,0.010 and 0.004,respectively).Area under the ROC curves(AUC)for FI-CD,FP,FS,and CFS for death prediction were 0.726,0.684,0.621 and 0.750,respectively(all P<0.001).Conclusion The assessed rates of frailty ranged from 23.5%(FS,CFS)to 33.8%(FP).Frailty is a risk factor of death.FI-CD and CFS are able to predict death in the elderly inpatients,and CFS outperforms the other methods.
作者
符琳琳
王青
张少景
徐颖
翟雪靓
陆菲
李华
FU Lin-Lin;WANG Qing;ZHANG Shao-Jing;XU Ying;ZHAI Xue-Liang;LU Fei;LI Hua(Department of General Medicine,Fuxing Hospital,Capital Medical University,Beijing 100038,China)
出处
《中华老年多器官疾病杂志》
2020年第9期651-655,共5页
Chinese Journal of Multiple Organ Diseases in the Elderly
基金
首都卫生发展科研专项项目(2016-2-7021)。
关键词
老年人
衰弱
衰弱评估
死亡
aged
frailty
frailty assessment
death
