Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
Mayo Clin Proc. 2023 Aug;98(8):1137-1152. doi: 10.1016/j.mayocp.2023.03.022.
To test whether biological age calculated using deficits, functional impairments, or their combination will provide improved estimation of long-term mortality among older adults undergoing percutaneous coronary intervention.
Cardiovascular deficits, noncardiovascular deficits, and functional impairments were prospectively studied in 535 patients aged 55 years or older from August 1, 2014, to March 31, 2018. Models for biological age included deficits (acquired, increase with age, associated with worse prognosis, did not saturate early), functional impairments (subjective-help with daily activities, difficulty with sensory input, continence, weight, balance, mobility; or objective-timed up and go, functional reach), or their combination.
The mean ± SD age of the study patients was 72.1±9.5 years. For every 5-year increase in chronological age, the mean number of cardiovascular deficits increased from 2.36 among patients younger than 70 years to 3.44 in nonagenarians. The mean number of functional impairments increased from 2.15 for those younger than 70 years to 6.74 for nonagenarians. During a median follow-up of 2.05 years, 99 patients died. Significant improvement in the Harrell concordance index (C index) for prediction of long-term all-cause mortality was noted with biological age calculated from deficits and impairments compared with chronological age (0.77 vs 0.65; P<.001) and when estimating biological age via functional impairments alone vs chronological age (0.75 vs 0.65; P<.001) but not via deficits alone (0.71 vs 0.65; P=.08). Biological age estimates from subjective functional impairments captured most of the prognostic information related to all-cause and noncardiac mortality, whereas deficit-based estimation favored cardiovascular mortality.
The derivation of biological age from deficits and functional impairments provides a major improvement in the estimation of survival as estimated by chronological age.
测试使用缺陷、功能障碍或两者结合来计算生物年龄是否能提高对接受经皮冠状动脉介入治疗的老年患者的长期死亡率的估计。
2014 年 8 月 1 日至 2018 年 3 月 31 日期间，前瞻性研究了 535 名年龄在 55 岁及以上的患者的心血管缺陷、非心血管缺陷和功能障碍。生物年龄模型包括缺陷（后天获得的、随年龄增长而增加的、与预后较差相关的、早期未饱和的）、功能障碍（主观上帮助日常生活活动、感觉输入困难、大小便失禁、体重、平衡、移动能力；或客观上计时起立和行走、功能性伸手距离）或两者的组合。
研究患者的平均年龄±标准差为 72.1±9.5 岁。每增加 5 岁的年龄，心血管缺陷的平均数量从 70 岁以下患者的 2.36 增加到 90 岁以上患者的 3.44。功能障碍的平均数量从 70 岁以下患者的 2.15 增加到 90 岁以上患者的 6.74。在中位数为 2.05 年的随访期间，有 99 名患者死亡。与年龄相比，用缺陷和障碍计算的生物年龄预测长期全因死亡率的哈雷尔一致性指数（C 指数）显著提高（0.77 比 0.65；P<.001），而仅用功能障碍估计的生物年龄与年龄相比（0.75 比 0.65；P<.001），而不是仅用缺陷估计的生物年龄（0.71 比 0.65；P=.08）。主观功能障碍估计的生物年龄捕捉到了与全因和非心脏死亡率相关的大部分预后信息，而基于缺陷的估计则有利于心血管死亡率。
从缺陷和功能障碍推导的生物年龄大大提高了根据年龄估计的生存率。
