虚弱-维生素 D 指数:一种用于快速老年评估的简明虚弱评估工具。

Frail-VIG index: a concise frailty evaluation tool for rapid geriatric assessment.

机构信息

Geriatric and Palliative Care Department, Hospital Universitari de la Santa Creu / Hospital Universitari de Vic, Rambla Hospital 52, 08500, Vic, Barcelona, Spain.

Department of Palliative Care, University of Vic / Central University of Catalonia, Barcelona, Spain.

出版信息

BMC Geriatr. 2018 Jan 26;18(1):29. doi: 10.1186/s12877-018-0718-2.

Abstract

BACKGROUND

Demographic changes have led to an increase in the number of elderly frail persons and, consequently, systematic geriatric assessment is more important than ever. Frailty Indexes (FI) may be particularly useful to discriminate between various degrees of frailty but are not routinely assessed due, at least in part, to the large number of deficits assessed (from 30 to 70). Therefore, we have developed a new, more concise FI for rapid geriatric assessment (RGA)-the Frail-VIG index ("VIG" is the Spanish/Catalan abbreviation for Comprehensive Geriatric Assessment), which contains 22 simple questions that assess 25 different deficits. Here we describe this FI and report its ability to predict mortality at 24 months.

METHODS

Prospective, observational, longitudinal study of geriatric patients followed for 24 months or until death. The study participants were patients (n = 590) admitted to the Acute Geriatric Unit at the at the University Hospital of Vic (Barcelona) during the year 2014. Participants were classified into one of seven groups based on their Frail-VIG score (0-0.15; 0.16-0.25; 0.26-0.35; 0.36-0.45; 0.46-0.55; 0.56-0.65; and 0.66-1). Survival curves for these groups were compared using the log-rank test. ROC curves were used to assess the index's capacity to predict mortality at 24 months.

RESULTS

Mean (standard deviation) patient age was 86.4 (5.6) years. The 24-month mortality rate was 57.3% for the whole sample. Significant between-group (deceased vs. living) differences (p < 0.05) were observed for most index variables. Survival curves for the seven Frail-VIG groups differed significantly (X = 433.4, p < 0.001), with an area under the ROC curve (confidence interval) of 0.90 (0.88-0.92) at 12 months and 0.85 (0.82-0.88) at 24 months. Administration time for the Frail-VIG index ranged from 5 to 10 min.

CONCLUSIONS

The Frail-VIG index, which requires less time to administer than previously validated FIs, presents a good discriminative capacity for the degree of frailty and a high predictive capacity for mortality in the present cohort. Although more research is needed to confirm the validity of this instrument in other populations and settings, the Frail-VIG may provide clinicians with a RGA method and also a reliable tool to assess frailty in routine practice.

摘要

背景

人口结构变化导致虚弱老年人的数量增加,因此,系统的老年评估比以往任何时候都更加重要。虚弱指数(FI)可以特别有用,用于区分不同程度的虚弱,但由于评估的缺陷数量众多(从 30 到 70),因此尚未常规进行评估。因此,我们开发了一种新的、更简洁的快速老年评估(RGA)-虚弱-VIG 指数(“VIG”是西班牙语/加泰罗尼亚语综合老年评估的缩写),它包含 22 个简单的问题,评估 25 种不同的缺陷。在此,我们描述了这个 FI,并报告了它预测 24 个月死亡率的能力。

方法

对 2014 年在巴塞罗那 Vic 大学医院急性老年病房接受 24 个月或直至死亡的老年患者进行前瞻性、观察性、纵向研究。研究参与者根据他们的 Frail-VIG 评分(0-0.15;0.16-0.25;0.26-0.35;0.36-0.45;0.46-0.55;0.56-0.65;0.66-1)分为七组之一。使用对数秩检验比较这些组的生存曲线。使用 ROC 曲线评估该指数预测 24 个月死亡率的能力。

结果

患者的平均(标准差)年龄为 86.4(5.6)岁。整个样本的 24 个月死亡率为 57.3%。大多数指数变量在死亡组和存活组之间存在显著差异(p<0.05)。七个 Frail-VIG 组的生存曲线差异显著(X=433.4,p<0.001),12 个月时 ROC 曲线下面积(置信区间)为 0.90(0.88-0.92),24 个月时为 0.85(0.82-0.88)。Frail-VIG 指数的管理时间为 5 至 10 分钟。

结论

Frail-VIG 指数比以前验证过的 FI 所需的管理时间更短,在本队列中具有良好的虚弱程度区分能力和高死亡率预测能力。虽然需要进一步的研究来证实该工具在其他人群和环境中的有效性,但 Frail-VIG 可以为临床医生提供一种 RGA 方法,也可以为常规实践中评估虚弱提供一种可靠的工具。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/266c/5787254/c2c8ac58973d/12877_2018_718_Fig1_HTML.jpg

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