衰弱与老年住院患者不良结局风险：不同衰弱测量指标的比较。

Frailty and Risk of Adverse Outcomes in Hospitalized Older Adults: A Comparison of Different Frailty Measures.

机构信息

Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore.

出版信息

J Am Med Dir Assoc. 2017 Jul 1;18(7):638.e7-638.e11. doi: 10.1016/j.jamda.2017.04.011. Epub 2017 Jun 3.

DOI:10.1016/j.jamda.2017.04.011

Abstract

OBJECTIVES: There is a paucity of data for the assessment of frailty in acutely ill hospitalized older adults. We aim to (1) compare the performance of frailty measures [5-item scale of fatigue, resistance, ambulation, illnesses, and loss of weight) (FRAIL), Tilburg Frailty Indicator (TFI), and Clinical Frailty Scale (CFS)] in identifying frailty, using the widely adopted Frailty Index (FI) as "gold standard," and (2) compare their ability to predict negative outcomes among hospitalized older adults. DESIGN: Prospective cohort study. SETTING: Acute inpatient care. PARTICIPANTS: A total of 210 patients (mean age 89.4 ± 4.6 years, 69.5% female) admitted to the Department of Geriatric Medicine. MEASUREMENTS: Premorbid frailty status was assessed by FI, FRAIL, TFI, and CFS. We collected data on comorbidities, severity of illness, functional status, and cognitive status. We compared area under receiver operator characteristic curves for FRAIL, TFI, and CFS against the reference FI. Multiple logistic regression was performed to examine the association between frailty and the primary outcome of in-hospital mortality. RESULTS: Frailty prevalence estimates were 87.1% (FI), 50% (FRAIL), 80% (TFI), and 81% (CFS). Area under receiver operator characteristics against FI ranged from 0.81 [95% confidence interval (CI) 0.72-0.90: FRAIL] to 0.91 (95% CI 0.87-0.95: CFS), with no significant difference on receiver operating characteristic curve contrast. Frailty, as defined by FRAIL score ≥3, was associated with higher in-hospital mortality (6.7% vs 1.0%, P = .031) and length of hospitalization [10 days (6.0-17.5) vs 8 days (5.0-14.0), P = .043]. FI [odds ratio (OR) = 1.15, 95% CI 1.00-1.33, P = .05], FRAIL (OR = 3.31, 95% CI 1.43-7.67, P = .005), and CFS (OR = 2.57, 95% CI 1.14-5.83, P = .023) independently predicted in-hospital mortality adjusted for age, sex, and severity of illness. CONCLUSIONS: FRAIL and CFS are simple frailty measures that may identify older adults at highest risk of adverse outcomes of hospitalization. FRAIL performed better in predicting in-hospital mortality.

摘要

目的：对于急性住院的老年患者，评估虚弱状态的数据很少。我们的目的是：(1) 通过广泛采用的衰弱指数 (FI) 作为“金标准”，比较五种疲劳、抵抗力、活动能力、疾病和体重减轻量表 (FRAIL)、蒂尔堡衰弱指标 (TFI) 和临床虚弱量表 (CFS) 在识别虚弱方面的表现；(2) 比较它们在预测住院老年患者不良结局方面的能力。

设计：前瞻性队列研究。

地点：急性住院护理。

参与者：共纳入 210 名患者（平均年龄 89.4±4.6 岁，69.5%为女性），他们被收入老年医学科。

测量：通过 FI、FRAIL、TFI 和 CFS 评估预患病前的虚弱状态。我们收集了合并症、疾病严重程度、功能状态和认知状态的数据。我们比较了 FRAIL、TFI 和 CFS 的受试者工作特征曲线下面积与参考 FI 的差异。采用多变量逻辑回归分析衰弱与住院期间死亡率这一主要结局的相关性。

结果：虚弱的患病率估计值分别为 87.1%（FI）、50%（FRAIL）、80%（TFI）和 81%（CFS）。与 FI 相比，接收器工作特征曲线的面积从 0.81（95%置信区间 0.72-0.90：FRAIL）到 0.91（95%置信区间 0.87-0.95：CFS）不等，在接收器操作特征曲线对比上没有显著差异。FRAIL 评分≥3 定义的虚弱与更高的住院期间死亡率（6.7%比 1.0%，P=.031）和住院时间相关[10 天（6.0-17.5）比 8 天（5.0-14.0），P=.043]。FI（比值比 [OR] 1.15，95%置信区间 1.00-1.33，P=.05）、FRAIL（OR 3.31，95%置信区间 1.43-7.67，P=.005）和 CFS（OR 2.57，95%置信区间 1.14-5.83，P=.023）在调整年龄、性别和疾病严重程度后，独立预测了住院期间的死亡率。

结论：FRAIL 和 CFS 是简单的虚弱测量方法，可以识别出最有可能发生住院不良结局的老年患者。FRAIL 在预测住院期间死亡率方面表现更好。