衰弱指标对癌症后脓毒症风险的中介效应。
Mediating Effects of Frailty Indicators on the Risk of Sepsis After Cancer.
机构信息
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.
出版信息
J Intensive Care Med. 2020 Jul;35(7):708-719. doi: 10.1177/0885066618779941. Epub 2018 Jun 3.
BACKGROUND
Cancer survivors are at increased risk of sepsis, possibly attributed to weakened physiologic conditions. The aims of this study were to examine the mediation effect of indicators of frailty on the association between cancer survivorship and sepsis incidence and whether these differences varied by race.
METHODS
We performed a prospective analysis using data from the REasons for Geographic and Racial Differences in Stroke cohort from years 2003 to 2012. We categorized frailty as the presence of ≥2 frailty components (weakness, exhaustion, and low physical activity). We categorized participants as "cancer survivors" or "no cancer history" derived from self-reported responses of being diagnosed with any cancer. We examined the mediation effect of frailty on the association between cancer survivorship and sepsis incidence using Cox regression. We repeated analysis stratified by race.
RESULTS
Among 28 062 eligible participants, 2773 (9.88%) were cancer survivors and 25 289 (90.03%) were no cancer history participants. Among a total 1315 sepsis cases, cancer survivors were more likely to develop sepsis (12.66% vs 3.81%, < .01) when compared to participants with no cancer history (hazard ratios: 2.62, 95% confidence interval: 2.31-2.98, < .01). The mediation effects of frailty on the log-hazard scale were very small: weakness (0.57%), exhaustion (0.31%), low physical activity (0.20%), frailty (0.75%), and total number of frailty indicators (0.69%). Similar results were observed when stratified by race.
CONCLUSION
Cancer survivors had more than a 2-fold increased risk of sepsis, and indicators of frailty contributed to less than 1% of this disparity.
背景
癌症幸存者发生脓毒症的风险增加，这可能归因于生理状况减弱。本研究旨在探讨衰弱指标对癌症存活与脓毒症发病率之间关联的中介效应，以及这些差异是否因种族而异。
方法
我们使用 2003 年至 2012 年 REasons for Geographic and Racial Differences in Stroke 队列的数据进行了前瞻性分析。我们将衰弱定义为存在≥2 个衰弱指标（虚弱、疲惫和低身体活动）。我们将参与者分为“癌症幸存者”或“无癌症史”，这是根据自我报告的被诊断患有任何癌症的结果得出的。我们使用 Cox 回归检验了衰弱对癌症存活与脓毒症发病率之间关联的中介效应。我们按种族进行了分层分析。
结果
在 28062 名合格参与者中，2773 名（9.88%）为癌症幸存者，25289 名（90.03%）为无癌症史参与者。在总共 1315 例脓毒症病例中，与无癌症史参与者相比，癌症幸存者发生脓毒症的可能性更高（12.66%比 3.81%，<0.01）（危险比：2.62，95%置信区间：2.31-2.98，<0.01）。衰弱对对数风险标度的中介效应非常小：虚弱（0.57%）、疲惫（0.31%）、低身体活动（0.20%）、衰弱（0.75%）和衰弱指标总数（0.69%）。按种族分层时也观察到了类似的结果。
结论
癌症幸存者发生脓毒症的风险增加了 2 倍以上，而衰弱指标仅导致了这一差异的不到 1%。
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