运用患者自评主观全面评定法识别住院老年人的脆弱前期和脆弱状态

Use of the Patient-Generated Subjective Global Assessment to Identify Pre-Frailty and Frailty in Hospitalized Older Adults.

作者信息

Han C Y, Sharma Y, Yaxley A, Baldwin C, Miller M

机构信息

Chad Yixian Han, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, SA5042, Australia, E-mail address:

出版信息

J Nutr Health Aging. 2021;25(10):1229-1234. doi: 10.1007/s12603-021-1704-5.

DOI:10.1007/s12603-021-1704-5

PMID:34866150

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12275529/

Abstract

OBJECTIVES

The Scored Patient-Generated Subjective Global Assessment (PG-SGA) and Edmonton Frail Scale (EFS) are widely used in acute care settings to assess nutritional and frailty status, respectively. We aimed to determine whether the scored PG-SGA can identify pre-frailty and frailty status, to simultaneously evaluate malnutrition and frailty in clinical practice.

DESIGN

Cross-sectional study.

SETTINGS AND PARTICIPANTS

A convenience sample of 329 consecutive patients admitted to an acute medical unit in South Australia.

MEASUREMENTS

Nutritional and frailty status were ascertained with scored PG-SGA and EFS, respectively. Optimal cut-off scores to identify pre-frailty and frailty were determined by calculating the Scored PG-SGA's sensitivity, specificity, positive and negative predictive values, Youden Index (YI), Liu index, Receiver Operator Curves (ROC) and Area Under Curve (AUC). Nutritional status and patient characteristics were analysed according to frailty categories.

RESULTS

The optimal cut-off PG-SGA score as determined by the highest YI, to identify both pre-frailty and frailty was >3, with a sensitivity of 0.711 and specificity of 0.746. The AUC was 0.782 (95% CI 0.731-0.833). In this cohort, 64% of the patients were well-nourished, 26% were moderately malnourished and 10% were severely malnourished. Forty-three percent, 24% and 33% of the patients were classified as robust, pre-frail and frail, respectively. Bivariate analysis showed that those robust were significantly younger than those who were pre-frail (-2.8, 95% CI -5.5 to -0.1, p=0.036) or frail (-3.4, 95% CI -5.9 to -1.0, p=0.002). Robust patients had significantly lower Scored PG-SGA than those who were pre-frail (-2.5, 95%CI -3.8 to -1.1, p<0.001) or frail (-4.9, 95% CI -6.1 to -3.7, p<0.001).

CONCLUSION

The Scored PG-SGA is moderately sensitive in identifying pre-frailty/frailty in older hospitalized adults and can be useful in identifying both conditions concurrently.

摘要

目的

计分患者主观全面评定法（PG-SGA）和埃德蒙顿虚弱量表（EFS）分别广泛应用于急性护理环境中评估营养状况和虚弱状态。我们旨在确定计分PG-SGA是否能够识别虚弱前期和虚弱状态，以便在临床实践中同时评估营养不良和虚弱情况。

设计

横断面研究。

地点和参与者

对南澳大利亚一家急性内科病房连续收治的329例患者进行便利抽样。

测量

分别使用计分PG-SGA和EFS确定营养状况和虚弱状态。通过计算计分PG-SGA的敏感性、特异性、阳性和阴性预测值、约登指数（YI）、刘指数、受试者工作特征曲线（ROC）和曲线下面积（AUC），确定识别虚弱前期和虚弱的最佳截断分数。根据虚弱类别分析营养状况和患者特征。

结果

由最高约登指数确定的识别虚弱前期和虚弱的最佳截断PG-SGA分数>3，敏感性为0.711，特异性为0.746。曲线下面积为0.782（95%可信区间0.731-0.833）。在该队列中，64%的患者营养良好，26%的患者中度营养不良，10%的患者重度营养不良。分别有43%、24%和33%的患者被分类为强壮、虚弱前期和虚弱。双变量分析显示，强壮的患者比虚弱前期患者（-2.8，95%可信区间-5.5至-0.1，p=0.036）或虚弱患者（-3.4，95%可信区间-5.9至-1.0，p=0.002）明显年轻。强壮患者的计分PG-SGA明显低于虚弱前期患者（-2.5，95%可信区间-3.8至-1.1，p<0.001）或虚弱患者（-4.9，95%可信区间-6.1至-3.7，p<0.001）。