COPD 患者的虚弱与死亡风险：比较 Fried 虚弱表型和简短体能测试的队列研究。
Frailty and Mortality Risk in COPD: A Cohort Study Comparing the Fried Frailty Phenotype and Short Physical Performance Battery.
机构信息
Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.
Harefield Respiratory Research Group, Royal Brompton and Harefield Hospitals, Guy's and St Thomas NHS Foundation Trust, London, UK.
出版信息
Int J Chron Obstruct Pulmon Dis. 2023 Jan 20;18:57-67. doi: 10.2147/COPD.S375142. eCollection 2023.
BACKGROUND
Identifying frailty in people with chronic obstructive pulmonary disease (COPD) is deemed important, yet comparative characteristics of the most commonly used frailty measures in COPD are unknown. This study aimed to compare how the Fried Frailty Phenotype (FFP) and Short Physical Performance Battery (SPPB) characterise frailty in people with stable COPD, including prevalence of and overlap in identification of frailty, disease and health characteristics of those identified as living with frailty, and predictive value in relation to survival time.
METHODS
Cohort study of people with stable COPD attending outpatient clinics. Agreement between frailty classifications was described using Cohen's Kappa. Disease and health characteristics of frail versus not frail participants were compared using t-, Mann-Whitney U and Chi-Square tests. Predictive value for mortality was examined with multivariable Cox regression.
RESULTS
Of 714 participants, 421 (59%) were male, mean age 69.9 years (SD 9.7), mean survival time 2270 days (95% CI 2185-2355). Similar proportions were identified as frail using the FFP (26.2%) and SPPB (23.7%) measures; classifications as frail or not frail matched in 572 (80.1%) cases, showing moderate agreement (Kappa = 0.469, SE = 0.038, p < 0.001). Discrepancies seemed driven by FFP exhaustion and weight loss criteria and the SPPB balance component. People with frailty by either measure had worse exercise capacity, health-related quality of life, breathlessness, depression and dependence in activities of daily living. In multivariable analysis controlling for the Age Dyspnoea Obstruction index, sex, BMI, comorbidities and exercise capacity, both the FFP and SPPB had predictive value in relation to mortality (FFP aHR = 1.31 [95% CI 1.03-1.66]; SPPB aHR = 1.29 [95% CI 0.99-1.68]).
CONCLUSION
In stable COPD, both the FFP and SPPB identify similar proportions of people living with/without frailty, the majority with matching classifications. Both measures can identify individuals with multidimensional health challenges and increased mortality risk and provide additional information alongside established prognostic variables.
背景
在患有慢性阻塞性肺疾病（COPD）的人群中识别衰弱状态被认为很重要，但目前尚不清楚最常用于 COPD 的衰弱测量方法的比较特征。本研究旨在比较 Fried 衰弱表型（FFP）和简短身体表现电池（SPPB）在稳定期 COPD 患者中的衰弱特征，包括衰弱的患病率以及识别衰弱的重叠，确定存在衰弱的患者的疾病和健康特征，以及与生存时间相关的预测价值。
方法
这是一项稳定期 COPD 门诊患者的队列研究。使用 Cohen 的 Kappa 描述衰弱分类的一致性。使用 t 检验、Mann-Whitney U 检验和卡方检验比较衰弱和非衰弱参与者的疾病和健康特征。使用多变量 Cox 回归检验死亡率的预测价值。
结果
在 714 名参与者中，421 名（59%）为男性，平均年龄 69.9 岁（标准差 9.7），平均生存时间为 2270 天（95%CI 2185-2355）。使用 FFP（26.2%）和 SPPB（23.7%）测量方法，有相似比例的人被确定为衰弱；在 572 例（80.1%）病例中，衰弱或非衰弱的分类匹配，显示出中等程度的一致性（Kappa = 0.469，SE = 0.038，p < 0.001）。差异似乎是由 FFP 衰竭和体重减轻标准以及 SPPB 平衡成分驱动的。通过任何一种方法确定为衰弱的患者的运动能力、健康相关生活质量、呼吸困难、抑郁和日常生活活动依赖均更差。在多变量分析中，控制年龄呼吸困难阻塞指数、性别、BMI、合并症和运动能力后，FFP 和 SPPB 均与死亡率相关（FFP aHR = 1.31[95%CI 1.03-1.66]；SPPB aHR = 1.29[95%CI 0.99-1.68]）。
结论
在稳定期 COPD 中，FFP 和 SPPB 都能识别出有或没有衰弱的人群，大多数人的分类是匹配的。两种方法都可以识别出具有多维健康挑战和更高死亡风险的个体，并提供与既定预后变量相关的补充信息。
Zotero 插件