Soong J, Poots A J, Scott S, Donald K, Bell D
NIHR CLAHRC Northwest London, Imperial College London, Chelsea and Westminster Campus, London, UK Royal College of Physicians, London, UK.
NIHR CLAHRC Northwest London, Imperial College London, Chelsea and Westminster Campus, London, UK.
BMJ Open. 2015 Oct 21;5(10):e008457. doi: 10.1136/bmjopen-2015-008457.
OBJECTIVES: Population ageing may result in increased comorbidity, functional dependence and poor quality of life. Mechanisms and pathophysiology underlying frailty have not been fully elucidated, thus absolute consensus on an operational definition for frailty is lacking. Frailty scores in the acute medical care setting have poor predictive power for clinically relevant outcomes. We explore the utility of frailty syndromes (as recommended by national guidelines) as a risk prediction model for the elderly in the acute care setting. SETTING: English Secondary Care emergency admissions to National Health Service (NHS) acute providers. PARTICIPANTS: There were N=2,099,252 patients over 65 years with emergency admission to NHS acute providers from 01/01/2012 to 31/12/2012 included in the analysis. PRIMARY AND SECONDARY OUTCOME MEASURES: Outcomes investigated include inpatient mortality, 30-day emergency readmission and institutionalisation. We used pseudorandom numbers to split patients into train (60%) and test (40%). Receiver operator characteristic (ROC) curves and ordering the patients by deciles of predicted risk was used to assess model performance. Using English Hospital Episode Statistics (HES) data, we built multivariable logistic regression models with independent variables based on frailty syndromes (10th revision International Statistical Classification of Diseases, Injuries and Causes of Death (ICD-10) coding), demographics and previous hospital utilisation. Patients included were those>65 years with emergency admission to acute provider in England (2012). RESULTS: Frailty syndrome models exhibited ROC scores of 0.624-0.659 for inpatient mortality, 0.63-0.654 for institutionalisation and 0.57-0.63 for 30-day emergency readmission. CONCLUSIONS: Frailty syndromes are a valid predictor of outcomes relevant to acute care. The models predictive power is in keeping with other scores in the literature, but is a simple, clinically relevant and potentially more acceptable measurement for use in the acute care setting. Predictive powers of the score are not sufficient for clinical use.
目的：人口老龄化可能导致合并症增加、功能依赖和生活质量下降。虚弱的机制和病理生理学尚未完全阐明，因此对于虚弱的操作定义缺乏绝对共识。急性医疗环境中的虚弱评分对临床相关结局的预测能力较差。我们探讨虚弱综合征（如国家指南所推荐）作为急性护理环境中老年人风险预测模型的效用。 设置：英国国家医疗服务体系（NHS）急性医疗机构的二级护理紧急入院情况。 参与者：分析纳入了2012年1月1日至2012年12月31日期间因紧急情况入院至NHS急性医疗机构的2,099,252名65岁以上患者。 主要和次要结局指标：调查的结局包括住院死亡率、30天紧急再入院率和机构化。我们使用伪随机数将患者分为训练组（60%）和测试组（40%）。使用受试者工作特征（ROC）曲线并按预测风险十分位数对患者进行排序来评估模型性能。利用英国医院事件统计（HES）数据，我们构建了基于虚弱综合征（国际疾病、损伤和死因分类第十版（ICD - 10）编码）、人口统计学和既往医院利用情况的独立变量多变量逻辑回归模型。纳入的患者为2012年在英格兰因紧急情况入院至急性医疗机构的65岁以上患者。 结果：虚弱综合征模型对住院死亡率的ROC评分为0.624 - 0.659，对机构化的评分为0.63 - 0.654，对30天紧急再入院率的评分为0.57 - 0.63。 结论：虚弱综合征是与急性护理相关结局的有效预测指标。该模型的预测能力与文献中的其他评分一致，但在急性护理环境中是一种简单、临床相关且可能更易接受的测量方法。该评分的预测能力不足以用于临床。
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