基于全面老年评估的多维预后指数可预测老年心力衰竭患者的短期死亡率。
Multidimensional Prognostic Index based on a comprehensive geriatric assessment predicts short-term mortality in older patients with heart failure.
机构信息
Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
出版信息
Circ Heart Fail. 2010 Jan;3(1):14-20. doi: 10.1161/CIRCHEARTFAILURE.109.865022. Epub 2009 Oct 22.
BACKGROUND
Multidimensional impairment of older patients may influence the clinical outcome of diseases. The aim of this study was to evaluate whether a Multidimensional Prognostic Index (MPI) based on a comprehensive geriatric assessment predicts short-term mortality in older patients with heart failure.
METHODS AND RESULTS
In this prospective study with a 1-month follow-up, 376 patients aged 65 and older with a diagnosis of heart failure were enrolled. A standardized comprehensive geriatric assessment that included information on functional (activities of daily living and instrumental activities of daily living), cognitive (Short Portable Mental Status Questionnaire), and nutritional status (Mini Nutritional Assessment), as well as on risk of pressure sore (Exton-Smith Scale), comorbidities (Cumulative Illness Rating Scale Index), medications, and social support network, was used to calculate the MPI for mortality using a previously validated algorithm. The New York Heart Association, the Enhanced Feedback for Effective Cardiac Treatment, and the Acute Decompensated Heart Failure National Registry regression model scores were also calculated. Higher MPI values were significantly associated with higher 30-day mortality, both in men (MPI-1, 2.8%; MPI-2, 15.3%; MPI-3, 47.4%; P=0.000) and women (MPI-1, 0%; MPI-2, 6.5%; MPI-3, 14.6%; P=0.011). The discrimination of the MPI was also good, with areas under the receiver operating characteristic curves (men: 0.83; 95% CI, 0.75 to 0.90; women: 0.80; 95% CI, 0.71 to 0.89) greater than receiver operating characteristic areas of New York Heart Association (men: 0.63; 95% CI, 0.57 to 0.69; P=0.015; women: 0.65; 95% CI, 0.55 to 0.75; P=0.064), Enhanced Feedback for Effective Cardiac Treatment (men: 0.69; 95% CI, 0.58 to 0.79; P=0.045; women: 0.71; 95% CI, 0.55 to 0.87; P=0.443), and Acute Decompensated Heart Failure National Registry scores (men: 0.65; 95% CI, 0.52 to 0.78; P=0.023; women: 0.67; 95% CI, 0.49 to 0.83, P=0.171).
CONCLUSIONS
The MPI, calculated from information collected in a standardized comprehensive geriatric assessment, is useful to estimate the risk of 1-month mortality in older patients with heart failure.
背景
老年患者的多维障碍可能会影响疾病的临床结果。本研究的目的是评估基于综合老年评估的多维预后指数（MPI）是否可以预测老年心力衰竭患者的短期死亡率。
方法和结果
在这项前瞻性研究中，对 376 名年龄在 65 岁及以上、诊断为心力衰竭的患者进行了为期 1 个月的随访。采用标准化的综合老年评估，包括功能（日常生活活动和工具性日常生活活动）、认知（简短便携式精神状态问卷）和营养状况（微型营养评估）、压疮风险（埃克顿-史密斯量表）、合并症（累积疾病评分指数）、药物治疗和社会支持网络信息，使用先前验证的算法计算死亡率的 MPI。还计算了纽约心脏协会、有效心脏治疗的强化反馈和急性失代偿性心力衰竭国家登记评分模型。较高的 MPI 值与 30 天死亡率显著相关，男性（MPI-1，2.8%；MPI-2，15.3%；MPI-3，47.4%；P=0.000）和女性（MPI-1，0%；MPI-2，6.5%；MPI-3，14.6%；P=0.011）。MPI 的判别能力也很好，接受者操作特征曲线下的面积（男性：0.83；95%置信区间，0.75 至 0.90；女性：0.80；95%置信区间，0.71 至 0.89）大于纽约心脏协会（男性：0.63；95%置信区间，0.57 至 0.69；P=0.015；女性：0.65；95%置信区间，0.55 至 0.75；P=0.064）、有效心脏治疗的强化反馈（男性：0.69；95%置信区间，0.58 至 0.79；P=0.045；女性：0.71；95%置信区间，0.55 至 0.87；P=0.443）和急性失代偿性心力衰竭国家登记评分（男性：0.65；95%置信区间，0.52 至 0.78；P=0.023；女性：0.67；95%置信区间，0.49 至 0.83，P=0.171）。
结论
从标准化综合老年评估中收集的信息计算出的 MPI 可用于估计老年心力衰竭患者 1 个月死亡率的风险。
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