Zhang Xiao-Ming, Wu Xinjuan, Ma Yunfen, Zhu Chen, Cao Jing, Liu Ge, Li Fang-Fang, Cheng Andy S K
Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan Campus), Beijing, 100730, People's Republic of China.
Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China.
Risk Manag Healthc Policy. 2021 Jun 2;14:2289-2300. doi: 10.2147/RMHP.S311692. eCollection 2021.
Immobile patients often suffer from malnutrition and low calf circumference (CC), a potential surrogate marker of low muscle mass, which has been widely explored as a link with mortality among patients with inconsistent results. In addition, studies comparing CC, BMI, and albumin to predict mortality among immobile patients are limited. The aim of our study was to compare the performance of these three parameters for predicting mortality among immobile patients.
This is a secondary analysis of our previous study consisting of immobile patients, age>18 years. Data were collected between November 2015 and March 2016 by trained nurses through a case report form (CRF) that included clinical data and sociodemographic variables. In addition, anthropometric parameters, including body weight, height and calf circumference, were also measured. The outcome of our study was mortality with follow-up length being 90 days. Multivariate linear and logistic regression analysis were adopted to identify the association between CC and mortality, and a receiver operating characteristic curve analysis was also used to compare the performance of CC, BMI, and albumin.
Of the 387 patients who were included (51.42% male), with an average age of 61.22 (SD=15.18), the prevalence of mortality was 5.43%. The results showed that, after full adjustment, calf circumference was a protective factor for reducing the risk of mortality (OR=0.79; 95%CI:0.65-0.96). Meanwhile, immobile patients with low calf circumference had an increased risk of mortality, compared to those whose condition was normal (OR=4.24; 95%CI:1.07-16.74). Receiver operating characteristic curve analysis showed that CC combined with albumin (AUC=0.812; 95% CI=0.733-0.890) had the highest AUC value compared to calf circumference (AUC=0.759; 95%CI:0.662-0.856), BMI (AUC=0.653; 95%CI:0.538-0.767) and albumin (AUC=0.735; 95% CI:0.638-0.832), respectively, in predicting mortality in immobile patients.
The relationship between calf circumference and mortality was significantly negative and low calf circumference was associated with a high risk of 90-day mortality, compared to those with normal calf circumference. The combined calf circumference with albumin had good discrimination in predicting mortality among immobile patients. Therefore, it can routinely be used in a clinical setting by medical staff to predict mortality in immobile patients, as it is easy to obtain.
行动不便的患者常伴有营养不良和小腿围度（CC）降低，小腿围度是肌肉量减少的一个潜在替代指标，作为与患者死亡率的关联因素已得到广泛研究，但结果并不一致。此外，比较CC、BMI和白蛋白对行动不便患者死亡率预测价值的研究有限。我们研究的目的是比较这三个参数对行动不便患者死亡率的预测性能。
这是对我们之前一项包含行动不便患者（年龄>18岁）的研究进行的二次分析。2015年11月至2016年3月期间，经过培训的护士通过一份包含临床数据和社会人口学变量的病例报告表（CRF）收集数据。此外，还测量了人体测量参数，包括体重、身高和小腿围度。我们研究的结局是死亡率，随访时长为90天。采用多变量线性和逻辑回归分析来确定CC与死亡率之间的关联，还使用受试者工作特征曲线分析来比较CC、BMI和白蛋白的性能。
纳入的387例患者中（男性占51.42%），平均年龄为61.22岁（标准差=15.18），死亡率为5.43%。结果显示，在进行充分调整后，小腿围度是降低死亡风险的一个保护因素（OR=0.79；95%置信区间：0.65 - 0.96）。同时，与小腿围度正常的行动不便患者相比，小腿围度低的患者死亡风险增加（OR=4.24；95%置信区间：1.07 - 16.74）。受试者工作特征曲线分析表明，与单独的小腿围度（AUC=0.759；95%置信区间：0.662 - 0.856）、BMI（AUC=0.653；95%置信区间：0.538 - 0.767）和白蛋白（AUC=0.735；95%置信区间：0.638 - 0.832）相比，CC与白蛋白联合使用（AUC=0.812；95%置信区间=0.733 - 0.890）在预测行动不便患者死亡率方面具有最高的AUC值。
小腿围度与死亡率之间呈显著负相关，与小腿围度正常的患者相比，小腿围度低的患者90天死亡风险较高。小腿围度与白蛋白联合使用在预测行动不便患者死亡率方面具有良好的辨别能力。因此，由于其易于获取，医护人员可在临床环境中常规使用它来预测行动不便患者的死亡率。
