验证 "(fr)AGILE"：一种快速识别老年人多维脆弱性的工具。
Validation of "(fr)AGILE": a quick tool to identify multidimensional frailty in the elderly.
机构信息
Department of Translational Medical Sciences, University of Naples "Federico II", Via S. Pansini, 80131, Naples, Italy.
IRCCS Salvatore Maugeri Foundation, Scientific Institute of Veruno, Novara, Italy.
出版信息
BMC Geriatr. 2020 Sep 29;20(1):375. doi: 10.1186/s12877-020-01788-1.
BACKGROUND
Several tools have been proposed and validated to operationally define frailty. Recently, the Italian Frailty index (IFi), an Italian modified version of Frailty index, has been validated but its use in clinical practice is limited by long time of administration. Therefore, the aim of this study was to create and validate a quick version of the IFi (AGILE).
METHODS
Validation study was performed by administering IFi and AGILE, after a Comprehensive Geriatric Assessment (CGA) in 401 subjects aged 65 or over (77 ± 7 years). AGILE was a 10-items tool created starting from the more predictive items of the four domains of frailty investigated by IFi (mental, physical, socioeconomic and nutritional). AGILE scores were stratified in light, moderate and severe frailty. At 24 months of follow-up, death, disability (taking into account an increase in ADL lost ≥1 from the baseline) and hospitalization were considered. Area under curve (AUC) was evaluated for both IFi and AGILE.
RESULTS
Administration time was 9.5 ± 3.8 min for IFi administered after a CGA, and 2.4 ± 1.2 min for AGILE, regardless of CGA (p < 0.001). With increasing degree of frailty, prevalence of mortality increased progressively from 6.5 to 41.8% and from 9.0 to 33.3%, disability from 16.1 to 64.2% and from 22.1 to 59.8% and hospitalization from 17.2 to 58.7% and from 27.0 to 52.2% with AGILE and IFi, respectively (p = NS). Relative Risk for each unit of increase in AGILE was 56, 44 and 24% for mortality, disability and hospitalization, respectively and was lower for IFi (8, 7 and 4% for mortality, disability and hospitalization, respectively). The AUC was higher in AGILE vs. IFi for mortality (0.729 vs. 0.698), disability (0.715 vs. 0.682) and hospitalization (0.645 vs. 0.630).
CONCLUSIONS
Our study shows that AGILE is a rapid and effective tool for screening multidimensional frailty, able to predict mortality, disability and hospitalization, especially useful in care settings that require reliable assessment instruments with short administration time.
背景
已经提出并验证了几种工具来操作定义虚弱。最近，意大利虚弱指数（IFi），是虚弱指数的意大利修订版，已经得到验证，但由于管理时间长，其在临床实践中的应用受到限制。因此，本研究的目的是创建和验证 IFi 的快速版本（AGILE）。
方法
在对 401 名 65 岁或以上（77±7 岁）的受试者进行全面老年评估（CGA）后，进行了 IFi 和 AGILE 的验证研究。AGILE 是一个 10 项工具，从 IFi 中调查的虚弱的四个领域（心理、身体、社会经济和营养）中更具预测性的项目开始创建。AGILE 评分分为轻度、中度和重度虚弱。在 24 个月的随访中，考虑死亡、残疾（考虑从基线丢失的 ADL 增加≥1）和住院。评估了 IFi 和 AGILE 的曲线下面积（AUC）。
结果
进行 CGA 后，IFI 的管理时间为 9.5±3.8 分钟，而进行 CGA 后，AGILE 的管理时间为 2.4±1.2 分钟，无论 CGA 如何（p<0.001）。随着虚弱程度的增加，死亡率的患病率从 6.5%逐渐增加到 41.8%，从 9.0%增加到 33.3%，残疾从 16.1%增加到 64.2%，从 22.1%增加到 59.8%，住院从 17.2%增加到 58.7%，从 27.0%增加到 52.2%，AGILE 和 IFi 分别（p=NS）。AGILE 每增加一个单位，死亡、残疾和住院的相对风险分别为 56%、44%和 24%，而 IFi 分别为 8%、7%和 4%（死亡、残疾和住院）。AGILE 的 AUC 高于 IFi 对于死亡率（0.729 与 0.698）、残疾（0.715 与 0.682）和住院（0.645 与 0.630）。
结论
我们的研究表明，AGILE 是一种快速有效的多维虚弱筛查工具，能够预测死亡率、残疾和住院，特别是在需要可靠评估工具且管理时间短的护理环境中有用。
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