Carey Elise C, Covinsky Kenneth E, Lui Li-Yung, Eng Catherine, Sands Laura P, Walter Louise C
Division of General Internal Medicine, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
J Am Geriatr Soc. 2008 Jan;56(1):68-75. doi: 10.1111/j.1532-5415.2007.01496.x. Epub 2007 Nov 20.
OBJECTIVES: To develop and validate a prognostic index for mortality in community-living, frail elderly people. DESIGN: Cohort study of Program of All-Inclusive Care for the Elderly (PACE) participants enrolled between 1988 and 1996. SETTING: Eleven PACE sites, a community-based long-term care program that cares for frail, chronically ill elderly people who meet criteria for nursing home placement. PARTICIPANTS: Three thousand eight hundred ninety-nine PACE enrollees. The index was developed in 2,232 participants and validated in 1,667. MEASUREMENTS: Time to death was predicted using risk factors obtained from a geriatric assessment performed by the PACE interdisciplinary team at the time of enrollment. Risk factors included demographic characteristics, comorbid conditions, and functional status. RESULTS: The development cohort had a mean age of 79 (68% female, 40% white). The validation cohort had a mean age of 79 (76% female, 65% white). In the development cohort, eight independent risk factors of mortality were identified and weighted, using Cox regression, to create a risk score: male sex, 2 points; age (75-79, 2 points; 80-84, 2 points; > or = 85, 3 points); dependence in toileting, 1 point; dependence in dressing (partial dependence, 1 point; full dependence, 3 points); malignant neoplasm, 2 points; congestive heart failure, 3 points; chronic obstructive pulmonary disease, 1 point; and renal insufficiency, 3 points. In the development cohort, respective 1- and 3-year mortality rates were 6% and 21% in the lowest-risk group (0-3 points), 12% and 36% in the middle-risk group (4-5 points), and 21% and 54% in the highest-risk group (> 5 points). In the validation cohort, respective 1- and 3-year mortality rates were 7% and 18% in the lowest-risk group, 11% and 36% in the middle-risk group, and 22% and 55% in the highest-risk group. The area under the receiver operating characteristic curve for the point score was 0.66 and 0.69 in the development and validation cohorts, respectively. CONCLUSION: A multidimensional prognostic index was developed and validated using age, sex, functional status, and comorbidities that effectively stratifies frail, community-living elderly people into groups at varying risk of mortality.
目的：开发并验证一种针对社区生活的体弱老年人死亡率的预后指数。 设计：对1988年至1996年间纳入老年人全面照护计划（PACE）的参与者进行队列研究。 设置：11个PACE站点，这是一个基于社区的长期护理项目，为符合养老院安置标准的体弱、慢性病老年人提供护理。 参与者：3899名PACE登记者。该指数在2232名参与者中开发，并在1667名参与者中进行验证。 测量：使用在入组时由PACE跨学科团队进行的老年评估所获得的风险因素预测死亡时间。风险因素包括人口统计学特征、合并症和功能状态。 结果：开发队列的平均年龄为79岁（68%为女性，40%为白人）。验证队列的平均年龄为79岁（76%为女性，65%为白人）。在开发队列中，确定了8个独立的死亡风险因素，并使用Cox回归进行加权，以创建一个风险评分：男性，2分；年龄（75 - 79岁，2分；80 - 84岁），2分；≥85岁，3分）；如厕依赖，1分；穿衣依赖（部分依赖，1分；完全依赖，3分）；恶性肿瘤，2分；充血性心力衰竭，3分；慢性阻塞性肺疾病，1分；肾功能不全，3分。在开发队列中，最低风险组（0 - 3分）的1年和3年死亡率分别为6%和21%，中风险组（4 - 5分）为12%和36%，高风险组（>5分）为21%和54%。在验证队列中，最低风险组的1年和3年死亡率分别为7%和18%，中风险组为11%和36%，高风险组为22%和55%。该评分在开发队列和验证队列中的受试者工作特征曲线下面积分别为0.66和0.69。 结论：使用年龄、性别、功能状态和合并症开发并验证了一种多维预后指数，该指数可有效地将社区生活的体弱老年人分层为具有不同死亡风险的组。
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