Huang Sha, Wang Yan, Chen Lanlan, Chen Xiaoyan
Southwest Medical University Zigong Affiliated Hospital, Zigong, Sichuan, China.
Southwest Medical University Zigong Affiliated Hospital, Zigong, Sichuan, China.
Arch Gerontol Geriatr. 2022 Jul-Aug;101:104692. doi: 10.1016/j.archger.2022.104692. Epub 2022 Mar 23.
Community-acquired pneumonia (CAP) is a common and potentially deadly infection that often arises in older adults. However, the relevance of frailty assessments in older CAP patients remains to be established. The present study was designed to assess the value of a pretreatment frailty index based upon routine laboratory parameters as a predictor of complication and mortality among older CAP patients.
Design: Retrospective cohort study.
One of the teaching hospitals in western China. Hospitalized CAP patients ≥ 60 years of age. Relevant data were gathered from medical records, local government mortality databases, and telephone interviews. Analyzed outcomes included complication (including respiratory failure and septic shock) and all-cause mortality. A frailty index was constructed based upon 44 pre-treatment laboratory parameters (FI-LAB), and then three cut-off values were selected to define individuals that were robust (0.0-0.2), pre-frail (0.2-0.35), and frail (≥0.35).
In total, this study incorporated 627 patients (60.77% male; median age: 80 years). Rates of respiratory failure, septic shock and death were higher for frail and prefrail individuals relative to robust individuals (30.13% vs 21.13% vs 6.59%, p < 0.001; 40.38% vs 15.02% vs 3.88%, p < 0.001; 73.08% vs 54.93% vs 24.42%, p < 0.001). Following adjustment for potential confounders, both the pre-frail and frail groups exhibited elevated risk of respiratory failure (OR = 3.326, 95%CI: 1.799-6.15; OR = 5.353, 95%CI: 2.835-10.107), higher risk of septic shock (OR = 3.701, 95%CI: 1.736-7.889; OR = 12.713, 95%CI: 6.112-26.445), and a higher risk of death (HR = 2.173, 95%CI: 1.576-2.996; HR = 2.877, 95%CI: 2.026-4.083) than the robust group.
Frailty, as defined using a scale based upon routine laboratory parameters, can predict a higher risk of complication and mortality in older CAP patients.
社区获得性肺炎（CAP）是一种常见且可能致命的感染，在老年人中经常发生。然而，老年CAP患者中衰弱评估的相关性仍有待确定。本研究旨在评估基于常规实验室参数的预处理衰弱指数作为老年CAP患者并发症和死亡率预测指标的价值。
设计：回顾性队列研究。
中国西部的一所教学医院。≥60岁的住院CAP患者。从病历、当地政府死亡率数据库和电话访谈中收集相关数据。分析的结果包括并发症（包括呼吸衰竭和感染性休克）和全因死亡率。基于44项预处理实验室参数构建衰弱指数（FI-LAB），然后选择三个临界值来定义健康（0.0 - 0.2）、衰弱前期（0.2 - 0.35）和衰弱（≥0.35）的个体。
本研究共纳入627例患者（男性占60.77%；中位年龄：80岁）。相对于健康个体，衰弱和衰弱前期个体的呼吸衰竭、感染性休克和死亡率更高（30.13%对21.13%对6.59%，p < 0.001；40.38%对15.02%对3.88%，p < 0.001；73.08%对54.93%对24.42%，p < 0.001）。在对潜在混杂因素进行调整后，衰弱前期和衰弱组的呼吸衰竭风险均升高（OR = 3.326，95%CI：1.799 - 6.15；OR = 5.353，95%CI：2.835 - 10.107），感染性休克风险更高（OR = 3.701，95%CI：1.736 - 7.889；OR = 12.713，95%CI：6.112 - 26.445），死亡风险也高于健康组（HR = 2.173，95%CI：1.576 - 2.996；HR = 2.877，95%CI：2.026 - 4.083）。
使用基于常规实验室参数的量表定义的衰弱可预测老年CAP患者发生并发症和死亡的风险更高。
