衰弱指数与阿尔茨海默病患者的死亡率、住院率及机构化：来自ICTUS研究的数据

Frailty Index and Incident Mortality, Hospitalization, and Institutionalization in Alzheimer's Disease: Data From the ICTUS Study.

作者信息

Kelaiditi Eirini, Andrieu Sandrine, Cantet Christelle, Vellas Bruno, Cesari Matteo

机构信息

Gérontopôle, Centre Hospitalier Universitaire de Toulouse, France.

Gérontopôle, Centre Hospitalier Universitaire de Toulouse, France. Inserm UMR1027, Université de Toulouse III Paul Sabatier, France.

出版信息

J Gerontol A Biol Sci Med Sci. 2016 Apr;71(4):543-8. doi: 10.1093/gerona/glv137. Epub 2015 Aug 13.

DOI:10.1093/gerona/glv137

PMID:26273022

Abstract

BACKGROUND

The identification of an objective evaluation of frailty capable of predicting adverse outcomes in Alzheimer's disease is increasingly discussed. The purpose of this study was to investigate whether the Frailty Index (FI) predicts hospitalization, institutionalization, and mortality in Alzheimer's disease patients.

METHODS

A prospective multicenter cohort study (follow-up = 2 years) that included 1,191 participants with Alzheimer's disease was carried out. The outcomes of interest were incident hospitalization, institutionalization, and mortality. The FI was calculated as the ratio of actual to thirty potential deficits, that is, deficits presented by the participant divided by 30. Severity of dementia was assessed using the Clinical Dementia Rating score. Cox proportional hazard models were performed.

RESULTS

Mean age of the study sample was 76.2 (SD = 7.6) years. A quadratic relationship of the FI with age was reported at baseline (R (2) = .045, p < .001). The FI showed a statistically significant association with mortality (age- and gender-adjusted hazard ratio [HR] = 1.019, 95% confidence interval [CI] = 1.002-1.037, p = .031) and hospitalization (age- and gender-adjusted HR = 1.017, 95% CI = 1.006-1.029, p = .004) and a borderline significance with institutionalization. When the Clinical Dementia Rating score was simultaneously included in the age- and gender-adjusted models, the FI confirmed its predictive capacity for hospitalization (HR = 1.019, 95% CI = 1.006-1.032, p = .004), whereas the Clinical Dementia Rating score was the strongest predictor for mortality (HR = 1.922, 95% CI = 1.256-2.941, p = .003) and institutionalization (HR = 1.955, 95%CI = 1.427-2.679, p < .001).

CONCLUSIONS

The FI is a robust predictor of adverse outcomes even after the stage of the underlying dementia is considered. Future work should evaluate the clinical implementation of the FI in the assessment of demented individuals in order to improve the personalization of care.

摘要

背景

关于确定一种能够预测阿尔茨海默病不良结局的衰弱客观评估方法的讨论日益增多。本研究的目的是调查衰弱指数（FI）是否能预测阿尔茨海默病患者的住院、机构化照护和死亡率。

方法

开展了一项前瞻性多中心队列研究（随访时间 = 2年），纳入了1191名阿尔茨海默病患者。感兴趣的结局为首次住院、机构化照护和死亡率。FI计算为实际缺陷数与30项潜在缺陷数的比值，即参与者出现的缺陷数除以30。使用临床痴呆评定量表评估痴呆严重程度。进行了Cox比例风险模型分析。

结果

研究样本的平均年龄为76.2（标准差 = 7.6）岁。在基线时报告了FI与年龄的二次关系（R² = 0.045，p < 0.001）。FI与死亡率（年龄和性别调整后的风险比[HR] = 1.019，95%置信区间[CI] = 1.002 - 1.037，p = 0.031）和住院率（年龄和性别调整后的HR = 1.017，95%CI = 1.006 - 1.029，p = 0.004）显示出统计学上的显著关联，与机构化照护有临界显著性。当在年龄和性别调整模型中同时纳入临床痴呆评定量表评分时，FI证实了其对住院的预测能力（HR = 1.019，95%CI = 1.006 - 1.032，p = 0.004），而临床痴呆评定量表评分是死亡率（HR = 1.922，95%CI = 1.256 - 2.941，p = 0.003）和机构化照护（HR = 1.955，95%CI = 1.427 - 2.679，p < 0.001）的最强预测因素。