Deng You, Lin Lin, Fan Xiaofei, Cui Binxin, Hou Lijun, Zhao Tianming, Hou Junjie, Mao Lihong, Wang Xiaoyu, Zhao Wei, Wang Bangmao, Yu Qingxiang, Sun Chao
Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Heping District, Tianjin, China.
Department of Gastroenterology, Tianjin Medical University General Hospital Airport Hospital, Tianjin, China.
Ther Adv Chronic Dis. 2020 May 18;11:2040622320922023. doi: 10.1177/2040622320922023. eCollection 2020.
The 5 m gait speed (5MGS), a simple and reliable performance metric and surrogate indicator of frailty, consistently predicts adverse events in elders. Additionally, MELD-Na (model for end-stage liver disease-sodium) scores fail to capture nutritional and functional decline of cirrhotic patients that may confer excess mortality. We hypothesized that 5MGS might be associated with all-cause mortality, and that inclusion of frailty assessment within MELD-Na could improve the prediction of mortality in cirrhosis.
5MGS was measured at baseline in 113 hospitalized cirrhotic patients. Survival status over 2 years and cirrhosis-related complications were recorded. We evaluated the prognostic value of 5MGS (as a continuous variable and as a dichotomous variable). The definition of slow preserved 5MGS was 0.8 ms based on previous publication. Using Cox proportional hazards regression, a novel MELDNa-5MGS score was derived. Receiver operating characteristics (ROC) curves estimated discrimination between the new score model and established prognostic indices.
The continuous 5MGS and slow 5MGS were independent predictors of all-cause mortality [5MGS: hazard ratio (HR) 0.133 (0.047-0.347), < 0.001; slow 5MGS: HR 4.805 (1.536-15.026), < 0.007]. The equation derived from Cox regression analysis was as follows: MELDNa-5MGS: MELD-Na score + 11 × slow 5MGS. The 2-year mortality in patients with high MELDNa-5MGS score was significantly higher ( < 0.001). Discriminatory power was significantly better for MELDNa-5MGS than MELD-Na score (AUC: 0.802 0.724, = 0.014 for 1 year; 0.773 0.709, = 0.044 for 2 years).
In cirrhotic patients, 5GMS is an independent risk factor of mortality. Modification of MELD-Na to include frailty estimated by low 5GMS is related to improved prognostication of mortality.
5米步行速度（5MGS）是一种简单可靠的性能指标和虚弱的替代指标，一直能够预测老年人的不良事件。此外，终末期肝病-钠（MELD-Na）评分未能反映可能导致额外死亡率的肝硬化患者的营养和功能衰退情况。我们假设5MGS可能与全因死亡率相关，并且在MELD-Na中纳入虚弱评估可以改善对肝硬化患者死亡率的预测。
对113例住院肝硬化患者在基线时测量5MGS。记录2年的生存状态和与肝硬化相关的并发症。我们评估了5MGS（作为连续变量和二分变量）的预后价值。根据先前的研究，5MGS缓慢的定义为≤0.8米/秒。使用Cox比例风险回归分析得出了一个新的MELDNa-5MGS评分。通过受试者工作特征（ROC）曲线评估新评分模型与既定预后指标之间的区分能力。
连续的5MGS和缓慢的5MGS是全因死亡率的独立预测因素[5MGS：风险比（HR）0.133（0.047 - 0.347），P < 0.001；缓慢的5MGS：HR 4.805（1.536 - 15.026），P < 0.007]。Cox回归分析得出的方程如下：MELDNa-5MGS：MELD-Na评分 + 11×缓慢的5MGS。MELDNa-5MGS评分高的患者2年死亡率显著更高（P < 0.001）。MELDNa-5MGS的区分能力显著优于MELD-Na评分（AUC：1年时为0.802对0.724，P = 0.014；2年时为0.773对0.709，P = 0.044）。
在肝硬化患者中，5MGS是死亡率的独立危险因素。对MELD-Na进行修改，纳入通过低5MGS评估的虚弱情况，与改善死亡率的预后评估相关。
