Ritt Martin, Ritt Julia Isabel, Sieber Cornel Christian, Gaßmann Karl-Günter
Institute for Biomedicine of Ageing (IBA), Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Nürnberg; Department of Internal Medicine III (Medicine of Ageing), Geriatrics Centre Erlangen, Hospital of the Congregation of St Francis Sisters of Vierzehnheiligen, Erlangen.
Department of Internal Medicine III (Medicine of Ageing), Geriatrics Centre Erlangen, Hospital of the Congregation of St Francis Sisters of Vierzehnheiligen, Erlangen.
Clin Interv Aging. 2017 Feb 8;12:293-304. doi: 10.2147/CIA.S124342. eCollection 2017.
Studies evaluating and comparing the power of frailty, comorbidity, and disability instruments, together and in parallel, for predicting mortality are limited.
This study aimed to evaluate and compare the measures of frailty, comorbidity, and disability in predicting 1-year mortality in geriatric inpatients.
Prospective cohort study.
A total of 307 inpatients aged ≥65 years in geriatric wards of a general hospital participated in the study.
The patients were evaluated in relation to different frailty, comorbidity, and disability instruments during their hospital stays. These included three frailty (the seven-category Clinical Frailty Scale [CFS-7], a 41-item frailty index [FI], and the FRAIL scale), two comorbidity (the Cumulative Illness Rating Scale for Geriatrics [CIRS-G] and the comorbidity domain of the FI [Comorbidity-D-FI]), and two disability instruments (disability in basic activities of daily living [ADL-Katz] and the instrumental and basic activities of daily living domains of the FI [IADL/ADL-D-FI]). The patients were followed-up over 1 year.
Using FI, CIRS-G, Comorbidity-D-FI, and ADL-Katz, this study identified a patient group with a high (≥50%) 1-year mortality rate in all of the patients and the two patient subgroups (ie, patients aged 65-82 years and ≥83 years). The CFS-7, FI, FRAIL scale, CIRS-G, Comorbidity-D-FI, and IADL/ADL-D-FI (analyzed as full scales) revealed useful discriminative accuracy for 1-year mortality (ie, an area under the curve >0.7) in all the patients and the two patient subgroups (all <0.001). Thereby, CFS-7 (in all patients and the two patient subgroups) and FI (in the subgroup of patients aged ≥83 years) showed greater discriminative accuracy for 1-year mortality compared to other instruments (all <0.05).
All the different instruments emerged as suitable tools for risk stratification in geriatric inpatients. Among them, CFS-7, and in those patients aged ≥83 years, also the FI, might most accurately predict 1-year mortality in the aforementioned group of individuals.
评估和比较衰弱、共病及残疾评估工具在预测死亡率方面的作用，将这些工具综合起来或平行比较的研究有限。
本研究旨在评估和比较衰弱、共病及残疾评估工具在预测老年住院患者1年死亡率方面的作用。
前瞻性队列研究。
一家综合医院老年病房的307名年龄≥65岁的住院患者参与了本研究。
在患者住院期间，使用不同的衰弱、共病及残疾评估工具对其进行评估。这些工具包括三种衰弱评估工具（七分类临床衰弱量表 [CFS-7]、41项衰弱指数 [FI] 和FRAIL量表）、两种共病评估工具（老年累积疾病评定量表 [CIRS-G] 和FI的共病领域 [共病-D-FI]）以及两种残疾评估工具（日常生活基本活动能力残疾 [ADL-Katz] 和FI的工具性日常生活活动及基本日常生活活动领域 [IADL/ADL-D-FI]）。对患者进行为期1年的随访。
使用FI、CIRS-G、共病-D-FI和ADL-Katz，本研究在所有患者以及两个患者亚组（即65 - 82岁患者和≥83岁患者）中识别出1年死亡率高（≥50%）的患者群体。CFS-7、FI、FRAIL量表、CIRS-G、共病-D-FI和IADL/ADL-D-FI（作为完整量表分析）在所有患者以及两个患者亚组中对1年死亡率显示出有效的判别准确性（即曲线下面积>0.7）（所有P<0.001）。因此，与其他工具相比，CFS-7（在所有患者和两个患者亚组中）和FI（在≥83岁患者亚组中）对1年死亡率显示出更高的判别准确性（所有P<0.05）。
所有不同的评估工具都是老年住院患者风险分层的合适工具。其中，CFS-7以及在≥83岁的患者中，FI可能最准确地预测上述人群的1年死亡率。
