Egashira Ryuichiro, Sato Tomoharu, Miyake Akimitsu, Takeuchi Mariko, Nakano Mai, Saito Hitomi, Moriguchi Misaki, Tonari Satoko, Hagihara Keisuke
Department of Advanced Hybrid Medicine, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan.
Department of Biostatistics and Data Science, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan.
Gene. 2022 Nov 30;844:146775. doi: 10.1016/j.gene.2022.146775. Epub 2022 Aug 22.
Frailty is one of the most important problems in a super-aged society. It is necessary to identify frailty quickly and easily at the bedside. We developed a simple patient-reported frailty screening scale, the Japan Frailty Scale (JFS), based on the aging concept of Kampo medicine. Eight candidate questions were prepared by Kampo medicine experts, and a simple prediction model was created in the development cohort (n = 434) and externally validated in an independent validation cohort (n = 276). The physical indicators and questionnaires associated with frailty were also comprehensively evaluated. The reference standard for frailty or pre-frailty was determined based on the Kihon checklist. In the development cohort, four questions, nocturia (0-2), lumbago (0-2), cold sensitivity (0-2), exhaustion (0-4), and age (0-1) were selected by multivariable logistic regression analysis. The total JFS score is 0-11. Receiver-operating characteristic curve analysis of the JFS for identifying frailty status showed moderately good discrimination (area under the curve (AUC) = 0.78, 95 % confidence interval (CI): 0.73-0.82). At the JFS cutoff value of 3/4 for frailty or pre-frailty, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 86.9 %, 53.3 %, 62.8 %, and 81.7 %, respectively. External validation of the JFS showed moderately good discrimination (AUC = 0.76, 95 % CI: 0.70-0.81). The sensitivity, specificity, PPV, and NPV were 79.9 %, 61.4 %, 69.3 %, and 73.7 %, respectively. These results indicate that the JFS is a promising patient-reported clinical scale for early identification of pre-frail/frail patients at the bedside in primary care.
衰弱是超老龄化社会中最重要的问题之一。在床边快速、轻松地识别衰弱情况很有必要。我们基于汉方医学的衰老概念，开发了一种简单的患者报告的衰弱筛查量表——日本衰弱量表（JFS）。汉方医学专家准备了8个候选问题，并在开发队列（n = 434）中创建了一个简单的预测模型，并在独立验证队列（n = 276）中进行了外部验证。还对与衰弱相关的身体指标和问卷进行了综合评估。根据基本健康检查表确定衰弱或衰弱前期的参考标准。在开发队列中，通过多变量逻辑回归分析选择了四个问题，夜尿症（0 - 2）、腰痛（0 - 2）、畏寒（0 - 2）、疲惫（0 - 4）和年龄（0 - 1）。JFS总分为0 - 11。用于识别衰弱状态的JFS的受试者工作特征曲线分析显示出中等良好的区分度（曲线下面积（AUC）= 0.78，95%置信区间（CI）：0.73 - 0.82）。对于衰弱或衰弱前期，JFS的截断值为3/4时，灵敏度、特异度、阳性预测值（PPV）和阴性预测值（NPV）分别为86.9%、53.3%、62.8%和81.7%。JFS的外部验证显示出中等良好的区分度（AUC = 0.76，95% CI：0.70 - 0.81）。灵敏度、特异度、PPV和NPV分别为79.9%、61.4%、69.3%和73.7%。这些结果表明，JFS是一种很有前景的患者报告临床量表，可用于在基层医疗中床边早期识别衰弱前期/衰弱患者。
