Caires Daniano, Costa Miguel Homem, Freitas João Miguel, Nascimento Rafael Ferreira, Teófilo Tiago, Ramos Dos Santos Luís, Gouveia João, Carvalhinha Carolina
Physical Medicine and Rehabilitation, Hospital Central do Funchal, Funchal, PRT.
Internal Medicine, Hospital Central do Funchal, Funchal, PRT.
Cureus. 2024 Sep 19;16(9):e69753. doi: 10.7759/cureus.69753. eCollection 2024 Sep.
Frailty is characterized by vulnerability and decline in physical, mental, and social activity, significantly contributing to adverse health outcomes. Frailty encompasses nutritional status, muscle strength, inflammation, and hormones. Dehydroepiandrosterone sulfate (DHEAS) is one of the hormones hypothesized to play a role in frailty. Handgrip strength (HGS) correlates with overall muscle strength. The fatigue, resistance, ambulation, illnesses, and loss of weight (FRAIL) scale can be used to readily screen frailty. Identifying markers associated with frailty can facilitate its early diagnosis, risk stratification, and target interventions to prevent or mitigate its negative consequences. This study sought to evaluate the associations between frailty, HGS, and DHEAS in a Portuguese frailty unit (FU).
We developed an observational retrospective study in an FU. Patients admitted to the FU underwent a rehabilitation program. We assessed frailty with the FRAIL scale. We assayed DHEAS upon admission to the FU. We measured HGS at admission (i-HGS) and discharge (f-HGS). We also considered HGS variation (∆ HGS) and length of stay.
Out of 119 subjects, 97 fulfilled the eligibility criteria (mean age 78.35 ± 9.58 years; 44.33% men). Overall, 88 (90.72%) patients had a FRAIL scale score of 3 or more. DHEAS values were not significantly different in either the categories of the FRAIL scale or frailty status. DHEAS values were also not significantly correlated with either i-HGS, f-HGS, ∆ HGS, age, or FU length of stay. Frail patients had a significantly lower i-HGS (p = 0.002) and f-HGS (p = 0.001) and a significantly higher length of stay (p = 0.006). Also, the i-HGS and f-HGS significantly decreased with the increase of the FRAIL scale score (p < 0.0001 for both). The cut-off values of the i-HGS and the f-HGS for detecting frail patients in our study were 13.3 kg and 19.1 kg, respectively (p < 0.0001 for both). The i-HGS was significantly and independently associated with the frailty status of frail (p = 0.001), with a 15% probability reduction of a patient being frail for every kilogram increase in the i-HGS.
Frail patients assessed with the FRAIL scale had a significantly lower i-HGS and f-HGS and a higher length of stay. In this study, we found frailty and DHEAS to be not associated and DHEAS values to be not correlated with i-HGS or f-HGS. In our opinion, the creation of an FU with an initial FRAIL scale screening and HGS measurement might have a significant impact on identifying frail people and ensuring the implementation of a multimodal multidisciplinary approach.
衰弱的特征是身体、心理和社会活动方面的脆弱性及功能衰退，这对不良健康结局有显著影响。衰弱包括营养状况、肌肉力量、炎症和激素等方面。硫酸脱氢表雄酮（DHEAS）是一种被认为在衰弱中起作用的激素。握力（HGS）与整体肌肉力量相关。疲劳、抵抗力、活动能力、疾病和体重减轻（FRAIL）量表可用于快速筛查衰弱。识别与衰弱相关的标志物有助于早期诊断、风险分层以及采取针对性干预措施，以预防或减轻其负面后果。本研究旨在评估葡萄牙一个衰弱单元（FU）中衰弱、HGS和DHEAS之间的关联。
我们在一个FU开展了一项观察性回顾性研究。入住该FU的患者接受了康复计划。我们使用FRAIL量表评估衰弱情况。患者入院时检测DHEAS。我们在入院时（i-HGS）和出院时（f-HGS）测量HGS。我们还考虑了HGS的变化（∆HGS）和住院时间。
119名受试者中，97名符合纳入标准（平均年龄78.35±9.58岁；44.33%为男性）。总体而言，88名（90.72%）患者的FRAIL量表评分达到3分或更高。DHEAS值在FRAIL量表类别或衰弱状态方面均无显著差异。DHEAS值也与i-HGS、f-HGS、∆HGS、年龄或FU住院时间均无显著相关性。衰弱患者的i-HGS（p = 0.002）和f-HGS（p = 0.001）显著更低，住院时间显著更长（p = 0.006）。此外，i-HGS和f-HGS均随FRAIL量表评分的增加而显著降低（两者p均<0.0001）。在我们的研究中，检测衰弱患者的i-HGS和f-HGS的临界值分别为13.3 kg和19.1 kg（两者p均<0.0001）。i-HGS与衰弱患者的衰弱状态显著且独立相关（p = 0.001），i-HGS每增加1千克，患者衰弱的概率降低15%。
使用FRAIL量表评估的衰弱患者的i-HGS和f-HGS显著更低，住院时间更长。在本研究中，我们发现衰弱与DHEAS不相关，且DHEAS值与i-HGS或f-HGS不相关。我们认为，创建一个初始进行FRAIL量表筛查和HGS测量的FU可能对识别衰弱人群以及确保实施多模式多学科方法有重大影响。
