Miguel-Ruano Guillermo, Aymerich-De-Franceschi María, García-Aroca Miguel Ángel, Benitez Edgar, Pérez-Fernández Nicolás, Álvarez-Avello José Manuel
Anesthesiology and Intensive Care Department, Clínica Universidad de Navarra, C/ Marquesado de Santa Marta 1, Madrid, 28027, Spain.
Anaesthesiology and Surgical Critical Care Department, Hospital Central de La Defensa Gómez Ulla, Glorieta Ejército 1, Latina, Madrid, 28047, Spain.
Perioper Med (Lond). 2025 Jun 23;14(1):63. doi: 10.1186/s13741-025-00549-1.
Frailty is a useful prognostic concept which has spread to many clinical settings, including perioperative medicine. However, there is no consensus on its definition. This situation could impair its screening and the correction of underlying disturbances that have an influence on the clinical course of ageing patients.
In order to achieve a more precise characterisation of frailty, an exploratory factor analysis (EFA) was performed on the variables of eight frailty scales: Clinical Frailty Scale (CFS), FRAIL scale, Edmonton scale, Fried criteria, Robinson scale, Risk Analysis Index, the Frailty Index and the Modified Frailty Index. Later, a concordance study between the factors found in EFA and frailty according to the CFS (≥ 4 points) was conducted. One-hundred nine preoperative patients aged 65 years or older (60% men) were included, and data were collected from medical history and physical and laboratory tests. Our aim was to explain the behaviour of well-known frailty-related variables by identifying the factors that influenced them and to investigate whether these factors were related to frailty.
Three factors were found, each relating to a different set of variables: F1 representing comorbidities; F2 being an aggregation of disturbances in physical activity, cognitive status and anaemia; and F3 portraying alterations of the emotional sphere. The concordance study showed a strong association of F2 with frailty: adjusted OR 3.65 (95% CI 1.57 to 8.53). F3 presented a milder relationship: OR 2.54 (95% CI 1.28 to 5.02). No association of F1 with frailty was found: OR 1.15 (95% CI 0.58 to 2.26).
In our quest to characterise frailty, we found that this is best described by an aggregate of reductions in physical activity, impairment in cognitive status and anaemia, while comorbidities are not associated with it. This could support a modified version of the phenotypic model against other paradigms.
衰弱是一个有用的预后概念，已应用于包括围手术期医学在内的许多临床环境。然而，其定义尚无共识。这种情况可能会影响对其的筛查以及对影响老年患者临床病程的潜在紊乱的纠正。
为了更精确地描述衰弱，对八个衰弱量表的变量进行了探索性因素分析（EFA）：临床衰弱量表（CFS）、FRAIL量表、埃德蒙顿量表、弗里德标准、罗宾逊量表、风险分析指数、衰弱指数和改良衰弱指数。随后，对EFA中发现的因素与根据CFS（≥4分）定义的衰弱之间进行了一致性研究。纳入了109名65岁及以上的术前患者（60%为男性），并从病史、体格检查和实验室检查中收集数据。我们的目的是通过识别影响衰弱相关变量的因素来解释其行为，并研究这些因素是否与衰弱相关。
发现了三个因素，每个因素与不同的变量集相关：F1代表合并症；F2是身体活动、认知状态和贫血紊乱的综合表现；F3描绘了情感领域的改变。一致性研究表明F2与衰弱有很强的关联：调整后的OR为3.65（95%CI为1.57至8.53）。F3的关联较弱：OR为2.54（95%CI为1.28至5.02）。未发现F1与衰弱有关联：OR为1.15（95%CI为0.58至2.26）。
在我们对衰弱进行特征描述的过程中，我们发现，身体活动减少、认知状态受损和贫血综合起来最能描述衰弱，而合并症与之无关。这可能支持对表型模型的一种修改版本，以对抗其他范式。
