Anagnostou Dimitrios, Theodorakis Nikolaos, Kalantzi Sofia, Spyridaki Aikaterini, Chitas Christos, Milionis Vassilis, Kollia Zoi, Christodoulou Michalitsa, Nella Ioanna, Spathara Aggeliki, Gourzoulidou Efi, Athinaiou Sofia, Triantafylli Gesthimani, Vamvakou Georgia, Nikolaou Maria
Geriatric Outpatient Clinic 65+, Sismanogleio-Amalia Fleming General Hospital, 14 25is Martiou Str., 15127 Melissia, Greece.
Department of Cardiology, Sismanogleio-Amalia Fleming General Hospital, 14 25is Martiou Str., 15127 Melissia, Greece.
Diagnostics (Basel). 2025 Jul 23;15(15):1857. doi: 10.3390/diagnostics15151857.
: To identify clinical, functional, laboratory, and patient-reported parameters associated with medium-term risk of hospitalization or death among older adults attending a multidisciplinary outpatient clinic, and to assess the predictive performance of these measures for individual risk stratification. : In this cohort study, 350 adults aged ≥65 years were assessed at baseline and followed for an average of 8 months. The primary outcome was a composite of hospitalization or all-cause mortality. Parameters assessed included frailty and comorbidity measures, functional parameters, such as gait speed and grip strength, laboratory biomarkers, and patient-reported measures, such as quality of life (QoL, assessed on a Likert scale) and the presence of depressive symptoms. Predictive performance was evaluated using univariable logistic regression and multivariable modeling. Discriminative ability was assessed via area under the ROC curve (AUC), and selected models were internally validated using repeated k-fold cross-validation. : Overall, 40 participants (11.4%) experienced hospitalization or death. Traditional clinical risk indicators, including frailty and comorbidity scores, were significantly associated with the outcome. Patient-reported QoL (AUC = 0.74) and Geriatric Depression Scale (GDS) scores (AUC = 0.67) demonstrated useful overall discriminatory ability, with high specificities at optimal cut-offs, suggesting they could act as "red flags" for adverse outcomes. However, the limited sensitivities of individual predictors underscore the need for more comprehensive screening instruments with improved ability to identify at-risk individuals earlier. A multivariable model that incorporated several predictors did not outperform QoL alone (AUC = 0.79), with cross-validation confirming comparable discriminative performance. : Patient-reported measures-particularly quality of life and depressive symptoms-are valuable predictors of hospitalization or death and may enhance traditional frailty and comorbidity assessments in outpatient geriatric care. Future work should focus on developing or integrating screening tools with greater sensitivity to optimize early risk detection and guide preventive interventions.
识别在多学科门诊就诊的老年人中期住院或死亡风险相关的临床、功能、实验室及患者报告参数，并评估这些指标用于个体风险分层的预测性能。
在这项队列研究中，对350名年龄≥65岁的成年人进行基线评估，并平均随访8个月。主要结局是住院或全因死亡率的综合指标。评估的参数包括衰弱和共病指标、功能参数（如步速和握力）、实验室生物标志物以及患者报告指标（如生活质量（采用李克特量表评估）和抑郁症状的存在情况）。采用单变量逻辑回归和多变量建模评估预测性能。通过ROC曲线下面积（AUC）评估判别能力，并使用重复k折交叉验证对所选模型进行内部验证。
总体而言，40名参与者（11.4%）经历了住院或死亡。包括衰弱和共病评分在内的传统临床风险指标与结局显著相关。患者报告的生活质量（AUC = 0.74）和老年抑郁量表（GDS）评分（AUC = 0.67）显示出有用的总体判别能力，在最佳截断值时具有高特异性，表明它们可作为不良结局的“警示信号”。然而，个体预测指标的敏感性有限，这凸显了需要更全面的筛查工具，以提高早期识别高危个体的能力。纳入多个预测指标的多变量模型的表现并未优于单独的生活质量指标（AUC = 0.79），交叉验证证实了类似的判别性能。
患者报告指标——尤其是生活质量和抑郁症状——是住院或死亡的有价值预测指标，可能会增强老年门诊护理中传统的衰弱和共病评估。未来的工作应侧重于开发或整合具有更高敏感性的筛查工具，以优化早期风险检测并指导预防性干预。
