Davenport Andrew
Department of Renal Medicine, Royal Free Hospital, University College London, London, UK.
Clin Kidney J. 2021 Nov 23;15(3):553-559. doi: 10.1093/ckj/sfab228. eCollection 2022 Mar.
To improve outcomes, simple screening tests are required to detect patients at increased risk of mortality. As patients with muscle weakness and wasting are at increased risk of death, we wished to review the use of the Clinical Frailty Score (CFS).
Dialysis staff graded haemodialysis (HD) patients attending for routine outpatient sessions using the CFS, a functional scoring scale, for patients who require help with their instrumental activities of daily living, classified as clinically frail with scores >4, which were compared with contemporaneous Stoke-Davies comorbidity scores, post-HD body composition measured by bioimpedance, hand grip strength (HGS) and standard laboratory investigations.
The results from 2089 patients (60.2% male) were reviewed, with 890 (42.6%) classified as frail. Frail patients were older [mean ± standard deviation (SD) 71.5 ± 15.6 versus 59.1 ± 15.6 years) and female (50.7% versus 37.3%) and had greater comorbidity {median 2 [interquartile range (IQR) 1-3] versus 1 [0-2]}, body mass index (BMI) (26.0 ± 6.7 versus 25.5 ± 5.4 kg/m), C-reactive protein (CRP) [8 (IQR 3-20) versus 5 (2-11) mg/L], lower serum albumin (37.6 ± 4.7 versus 40.1 ± 4.7 g/L), lean BMI (8.9 ± 1.7 versus 9.7 ± 1.6 kg/m) and HGS [13.4 (IQR 9.6-18.8) versus 20.9 (14.5-29) kg] (all P < 0.001). Frailty was independently associated in a multivariable logistic model with age {odds ratio [OR] 2.33 [95% confidence limit (CL) 2.01-2.7]}, body fat mass [OR 1.02 (CL 1.01-1.03)], log CRP [OR 1.63 (CL 1.28-2.07)] (all P < 0.001) and comorbidity [OR 1.45 (CL 1.17-1.8); P = 0.001] and negatively associated with albumin [OR 0.95 (CL 0.92-0.98) and HGS [OR 0.91 (CL 0.9-0.93)] (both P < 0.001).
Frail patients are at increased risk of mortality and, as such, simple reliable screening tools are required to rapidly detect patients at risk. The CFS is a useful screening tool that can be readily performed by dialysis staff to identify frail patients. Frailty in HD patients was associated with increasing age, comorbidity, fat weight and inflammation and reduced muscle strength and muscle mass. There is an overlap between frailty and both sarcopenia and protein energy wasting, which requires additional assessments, potentially including body composition, strength, dietary assessments and laboratory investigations. In addition, as the CFS offers a scale, patient trajectories can potentially be serially monitored over time, thus allowing patient-specific interventions or holistic care plans.
为改善治疗效果，需要简单的筛查测试来检测死亡风险增加的患者。由于肌肉无力和消瘦的患者死亡风险增加，我们希望回顾临床衰弱评分（CFS）的应用情况。
透析工作人员使用CFS（一种功能评分量表）对参加常规门诊的血液透析（HD）患者进行分级，该量表用于评估需要帮助进行日常生活工具性活动的患者，临床衰弱定义为评分>4分。将这些患者与同期的斯托克 - 戴维斯合并症评分、通过生物电阻抗测量的透析后身体成分、握力（HGS）以及标准实验室检查结果进行比较。
对2089例患者（60.2%为男性）的结果进行了回顾，其中890例（42.6%）被分类为衰弱。衰弱患者年龄更大[平均±标准差（SD）71.5±15.6岁对59.1±15.6岁]，女性比例更高（50.7%对37.3%），合并症更多{中位数2 [四分位间距（IQR）1 - 3]对1 [0 - 2]}，体重指数（BMI）（26.0±6.7对25.5±5.4 kg/m²），C反应蛋白（CRP）[8（IQR 3 - 20）对5（2 - 11）mg/L]，血清白蛋白更低（37.6±4.7对40.1±4.7 g/L），瘦体重BMI（8.9±1.7对9.7±1.6 kg/m²）以及HGS[13.4（IQR 9.6 - 18.8）对20.9（14.5 - 29）kg]（所有P<0.001）。在多变量逻辑模型中，衰弱与年龄{比值比[OR] 2.33 [95%置信区间（CL）2.01 - 2.7]}、体脂肪量[OR 1.02（CL 1.01 - 1.03）]、log CRP[OR 1.63（CL 1.28 - 2.07）]（所有P<0.001）以及合并症[OR 1.45（CL 1.17 - 1.8）；P = 0.001]独立相关，与白蛋白[OR 0.95（CL 0.92 - 0.98）]和HGS[OR 0.91（CL 0.9 - 0.93）]呈负相关（两者P<0.001）。
衰弱患者死亡风险增加，因此需要简单可靠的筛查工具来快速检测有风险的患者。CFS是一种有用的筛查工具，透析工作人员可以很容易地进行操作以识别衰弱患者。HD患者的衰弱与年龄增加、合并症、脂肪重量和炎症以及肌肉力量和肌肉量减少有关。衰弱与肌肉减少症和蛋白质能量消耗之间存在重叠，这需要额外的评估，可能包括身体成分、力量、饮食评估和实验室检查。此外，由于CFS提供了一个量表，可以随着时间对患者轨迹进行连续监测，从而制定针对患者的干预措施或整体护理计划。
