老年医学体检问卷（QMCOO）评分界值诊断衰弱的验证。
Validation of the questionnaire for medical checkup of old-old (QMCOO) score cutoff to diagnose frailty.
机构信息
Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Department of Rehabilitation Medicine, Asahi Neurology and Rehabilitation Hospital, Matsudo, Japan.
出版信息
BMC Geriatr. 2023 Mar 21;23(1):157. doi: 10.1186/s12877-023-03885-3.
BACKGROUND
Frailty is a state of increased vulnerability to poor resolution of homeostasis following a stress. Early diagnosis and intervention of frailty are essential to prevent its adverse outcomes. However, simple diagnostic criteria have not been established. The Questionnaire for Medical Checkup of Old-Old (QMCOO) is widely used for medical checkups of older adults in Japan. In our previous report, we developed a method to score the QMCOO and showed that frailty can be diagnosed with the highest accuracy when the score cutoff was set at 3/4 points. We aimed to validate the criteria in a larger cohort.
METHODS
Participants aged 65 years or over were recruited in the western region of Japan. They answered all the items of the Kihon Checklist (KCL) and the QMCOO. Based on the KCL score, they were diagnosed as robust (3 or lower), prefrail (4 to 7), or frail (8 or over). Then we tested the effectiveness to diagnose frailty using the QMCOO cutoff of 3/4 points. We also aimed to determine the score cutoff to separate robust and prefrail.
RESULTS
7,605 participants (3,458 males and 4,147 females, age 77.4 ± 6.9 years) were recruited. 3,665 participants were diagnosed as robust, 2,448 were prefrail, and 1,492 were frail based on the KCL score. The diagnosis of frailty had a sensitivity of 84.0%, specificity of 82.5%, and accuracy of 82.8% with a QMCOO score cutoff of 3/4 points, suggesting its validity. To separate robust and prefrail, both the accuracy and the Youden index were the highest with the QMCOO cutoff of 2/3 points (sensitivity, specificity, and accuracy were 63.9%, 83.4%, and 75.6%, respectively). All the questions of the QMCOO except Q12 (about smoking) were significantly related to prefrailty status after a logistic regression analysis.
CONCLUSION
Diagnosis of frailty using the QMCOO score cutoff of 3/4 points was validated. Prefrailty could be diagnosed using the score cutoff of 2/3 points.
背景
衰弱是一种在应激后对内稳态无法完全恢复的脆弱状态。早期诊断和干预衰弱对于预防其不良后果至关重要。然而，目前尚未建立简单的诊断标准。《高龄老年人医学检查问卷》（QMCOO）在日本被广泛用于老年人的体检。在我们之前的报告中，我们开发了一种评分方法，并表明当评分截点设定为 3/4 分时，衰弱的诊断准确性最高。我们旨在更大的队列中验证该标准。
方法
在日本西部地区招募年龄在 65 岁及以上的参与者。他们回答了 Kihon Checklist（KCL）和 QMCOO 的所有项目。根据 KCL 评分，他们被诊断为强壮（3 分或更低）、衰弱前期（4 到 7 分）或衰弱（8 分或更高）。然后，我们测试了使用 QMCOO 截点 3/4 分诊断衰弱的有效性。我们还旨在确定区分强壮和衰弱前期的评分截点。
结果
共招募了 7605 名参与者（3458 名男性和 4147 名女性，年龄 77.4±6.9 岁）。根据 KCL 评分，3665 名参与者被诊断为强壮，2448 名参与者被诊断为衰弱前期，1492 名参与者被诊断为衰弱。QMCOO 评分截点为 3/4 分时，衰弱的诊断灵敏度为 84.0%，特异性为 82.5%，准确性为 82.8%，表明其有效性。为了区分强壮和衰弱前期，QMCOO 截点为 2/3 分时，准确性和 Youden 指数均最高（灵敏度、特异性和准确性分别为 63.9%、83.4%和 75.6%）。逻辑回归分析后，除了关于吸烟的问题 12 之外，QMCOO 的所有问题都与衰弱前期状态显著相关。
结论
使用 QMCOO 评分截点 3/4 分诊断衰弱得到了验证。使用评分截点 2/3 分可以诊断衰弱前期。
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