Department of Community Healthcare and Geriatrics, Graduate School of Medicine, Nagoya University, Nagoya, Japan.
Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan.
Arch Gerontol Geriatr. 2020 Sep-Oct;90:104155. doi: 10.1016/j.archger.2020.104155. Epub 2020 Jun 15.
Low physical function is associated with poor outcomes in hospitalized patients; however, little is known about vulnerable populations such as those aged ≥ 75 years. We examined whether the Short Physical Performance Battery (SPPB) was associated with clinical outcomes in hospitalized patients aged ≥ 75 years.
In total, 147 patients aged ≥ 75 years (mean age, 86.5 ± 4.7 years; 89 males) completed the SPPB and Mini-Mental State Examination (MMSE) before hospital discharge. Patients were divided into three groups by SPPB score: 0 (unable to perform SPPB), 1-6 (low performance), and 7-12 (high performance). The first occurrence of all-cause unplanned readmission or all-cause mortality within 1 year after discharge was set as the endpoint.
The median SPPB score of the study population was 2; 41 % were unable to perform SPPB, 33 % had low performance, and 26 % had high performance. High SPPB was associated with younger age, higher body weight, and higher MMSE score. During the follow-up period, 35 (23.8 %) patients were readmitted to hospital and 19 (12.9 %) died. Even after adjusting for covariates, SPPB score was a significant and independent predictor of poor outcomes (hazard ratio for 1 point increase in SPPB, 0.88; P = .002). The subgroup analysis showed SPPB was inversely associated with the occurrence of poor outcomes in patients with cognitive impairment.
SPPB is inversely associated with risks for readmission and mortality in hospitalized patients aged ≥ 75 years, especially those with cognitive impairment. The present results indicate the SPPB is useful for accurate prognosis in hospital settings.
身体机能较低与住院患者的预后不良相关;然而,对于年龄≥75 岁的脆弱人群(如老年人),我们知之甚少。本研究旨在探讨简易体能状况评估量表(SPPB)与≥75 岁住院患者临床结局的相关性。
共纳入 147 名年龄≥75 岁(平均年龄 86.5±4.7 岁,男性 89 名)的患者,在出院前完成 SPPB 和简易精神状态检查(MMSE)。根据 SPPB 评分将患者分为三组:0 分(无法进行 SPPB)、1-6 分(低机能)和 7-12 分(高机能)。出院后 1 年内全因非计划性再入院或全因死亡的首次发生作为终点事件。
研究人群的 SPPB 中位数评分为 2 分;41%的患者无法进行 SPPB,33%的患者机能较低,26%的患者机能较高。高 SPPB 与年龄较小、体重较高和 MMSE 评分较高相关。在随访期间,35 名(23.8%)患者再次住院,19 名(12.9%)患者死亡。即使在校正了协变量后,SPPB 评分仍是不良结局的显著独立预测因素(SPPB 评分每增加 1 分,风险比为 0.88;P=0.002)。亚组分析显示,SPPB 与认知障碍患者不良结局的发生呈负相关。
SPPB 与≥75 岁住院患者的再入院和死亡风险呈负相关,尤其在认知障碍患者中。本研究结果表明,SPPB 在医院环境中对准确预后具有一定价值。