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中国人民解放军总医院老年心血管病研究所
中国科技出版传媒股份有限公司
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中华老年多器官疾病杂志编辑委员会
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创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
符琳琳,王青,张少景,徐颖,翟雪靓,陆菲,李华.四种衰弱评估工具对老年住院患者出院后全因死亡预测效果比较[J].中华老年多器官疾病杂志,2020,19(9):651~655
四种衰弱评估工具对老年住院患者出院后全因死亡预测效果比较
Comparison of four frailty assessment methods for predicting all-cause deaths in discharged elderly inpatients
投稿时间:2020-02-26  
DOI:10.11915/j.issn.1671-5403.2020.09.152
中文关键词:  老年人;衰弱;衰弱评估;死亡
英文关键词:aged; frailty; frailty assessment; death This work was supported by the Special Project of Scientific Research of Capital Health Development
基金项目:首都卫生发展科研专项项目(2016-2-7021)
作者单位E-mail
符琳琳 首都医科大学附属复兴医院综合科,北京100038 fxyywang@sina.comcomparison 
王青 首都医科大学附属复兴医院综合科,北京100038 fxyywang@sina.comcomparison 
张少景 首都医科大学附属复兴医院综合科,北京100038 fxyywang@sina.comcomparison 
徐颖 首都医科大学附属复兴医院综合科,北京100038 fxyywang@sina.comcomparison 
翟雪靓 首都医科大学附属复兴医院综合科,北京100038 fxyywang@sina.comcomparison 
陆菲 首都医科大学附属复兴医院综合科,北京100038 fxyywang@sina.comcomparison 
李华 首都医科大学附属复兴医院综合科,北京100038 fxyywang@sina.comcomparison 
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中文摘要:
      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。
英文摘要:
      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.
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