Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
Department of Cardiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
Front Endocrinol (Lausanne). 2024 Aug 5;15:1424257. doi: 10.3389/fendo.2024.1424257. eCollection 2024.
Frailty is a severe, common co-morbidity associated with congestive heart failure (CHF). This retrospective cohort study assesses the association between frailty and the risk of mortality in critically ill CHF patients.
Eligible patients with CHF from the Medical Information Base for Intensive Care IV database were retrospectively analyzed. The frailty index based on laboratory tests (FI_Lab) index was calculated using 33 variables to assess frailty status. The primary outcomes were in-hospital mortality and one-year mortality. The secondary outcomes were the incidence of acute kidney injury (AKI) and the administration of renal replacement therapy (RRT) in patients with concurrent AKI. Survival disparities among the FI_Lab subgroups were estimated with Kaplan-Meier survival analysis. The association between the FI_Lab index and mortality was examined with Cox proportional risk modeling.
A total of 3273 adult patients aged 18 years and older were enrolled in the study, with 1820 men and 1453 women included. The incidence rates of in-hospital mortality and one-year mortality rate were 0.96 per 1,000 person-days and 263.8 per 1,000 person-years, respectively. Multivariable regression analysis identified baseline FI_Lab > 0.45 as an independent risk factor predicting in-hospital mortality (odds ratio = 3.221, 95% CI 2.341-4.432, < 0.001) and one-year mortality (hazard ratio=2.152, 95% CI: 1.730-2.678, < 0.001). In terms of predicting mortality, adding FI_Lab to the six disease severity scores significantly improved the overall performance of the model (all < 0.001).
We established a positive correlation between the baseline FI_Lab and the likelihood of adverse outcomes in critical CHF patients. Given its potential as a reliable prognostic tool for such patients, further validation of FI_Lab across multiple centers is recommended for future research.
衰弱是一种严重且常见的合并症，与充血性心力衰竭（CHF）有关。本回顾性队列研究评估了衰弱与危重心力衰竭患者死亡风险之间的关系。
从重症监护 IV 数据库的医学信息基础中回顾性分析符合条件的 CHF 患者。使用 33 个变量计算基于实验室检查的衰弱指数（FI_Lab）指数，以评估衰弱状态。主要结局为院内死亡率和一年死亡率。次要结局为并发急性肾损伤（AKI）患者的 AKI 发生率和肾脏替代治疗（RRT）的应用。使用 Kaplan-Meier 生存分析估计 FI_Lab 亚组之间的生存差异。使用 Cox 比例风险模型检查 FI_Lab 指数与死亡率之间的关系。
共纳入 3273 名 18 岁及以上的成年患者，其中男性 1820 人，女性 1453 人。院内死亡率和一年死亡率的发生率分别为每 1000 人日 0.96 例和每 1000 人年 263.8 例。多变量回归分析确定基线 FI_Lab>0.45 是预测院内死亡率（优势比=3.221，95%CI：2.341-4.432，<0.001）和一年死亡率（风险比=2.152，95%CI：1.730-2.678，<0.001）的独立危险因素。在预测死亡率方面，将 FI_Lab 添加到六个疾病严重程度评分中显著提高了模型的整体性能（均<0.001）。
我们发现基线 FI_Lab 与危重心力衰竭患者不良结局的发生几率呈正相关。鉴于其作为此类患者可靠预后工具的潜力，建议在未来的研究中在多个中心进一步验证 FI_Lab。
