Nygaard Hanne, Henriksen Marius, Suetta Charlotte, Ekmann Anette
Department of Emergency Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital.
Geriatric Research Unit, Department of Geriatric and Palliative Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital.
Dan Med J. 2022 Jul 6;69(8):A11210866.
Frailty is a clinical syndrome that arises due to age-related decline, diseases, malnutrition and lifestyle. Two major perspectives on frailty exists: frailty as a phenotype and frailty as an accumulation of deficits. The two types are measured by Fried's Phenotype (FP) and the Clinical Frailty Scale (CFS), respectively. The aim of this study was to investigate which model best predicts 90-day mortality in elderly patients acutely admitted to an emergency department in Denmark.
This study comprised a prospective cohort with the following inclusion criteria: age > 65 years, acute admission and admission >24 h. Bispebjerg Hospital, Odense University Hospital and Hospital of Southwest Jutland participated in the study. The FP and the CFS were measured in all patients. Descriptive statistics, relative risk (RR), odds ratio (OR), risk difference and receiver-operating characteristics (ROC) analysis were performed. The outcome was 90-day mortality.
A total of 1,030 patients participated (mean age: 78.2 years, 54% female). Among these, 221 were frail by the FP (score > 3) and 555 participants were frail by the CFS (score > 5). Within 90 days, 128 died. The analyses revealed significant associations between frailty and 90-day mortality. For the FP, the RR was 2.67 (95% confidence interval (CI): 1.93-3.69), p less-than 0.001; and for the CFS, the RR was 4.12 (95% CI: 2.65-6.42), p less-than 0.001. The adjusted OR for the CFS was 4.38 (95% CI: 2.68-7.13); for the FP, 3.88 (95% CI: 2.51-6.01).
A significant association existed between frailty and 90-day mortality in the Danish cohort. However, the CFS is a better predictor of 90-day mortality the FP. Even so, the CFS still has a lack of sensitivity and specificity.
none TRIAL REGISTRATION. not relevant.
衰弱是一种因年龄相关衰退、疾病、营养不良和生活方式而出现的临床综合征。关于衰弱存在两种主要观点：衰弱作为一种表型以及衰弱作为缺陷的累积。这两种类型分别通过弗里德表型（FP）和临床衰弱量表（CFS）来衡量。本研究的目的是调查哪种模型能最好地预测丹麦急诊科急性收治的老年患者的90天死亡率。
本研究包括一个前瞻性队列，纳入标准如下：年龄>65岁、急性入院且住院时间>24小时。比斯佩比约格医院、欧登塞大学医院和日德兰西南部医院参与了该研究。对所有患者测量FP和CFS。进行描述性统计、相对风险（RR）、比值比（OR）、风险差异和受试者工作特征（ROC）分析。结局为90天死亡率。
共有1030名患者参与（平均年龄：78.2岁，54%为女性）。其中，221名患者根据FP判定为衰弱（得分>3），555名参与者根据CFS判定为衰弱（得分>5）。在90天内，128人死亡。分析显示衰弱与90天死亡率之间存在显著关联。对于FP，RR为2.67（95%置信区间（CI）：1.93 - 3.69），p<0.001；对于CFS，RR为4.12（95%CI：2.65 - 6.42），p<0.001。CFS的校正OR为4.38（95%CI：2.68 - 7.13）；对于FP，为3.88（95%CI：2.51 - 6.01）。
在丹麦队列中，衰弱与90天死亡率之间存在显著关联。然而，CFS比FP能更好地预测90天死亡率。即便如此，CFS仍缺乏敏感性和特异性。
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