Yang Zhenkun, Wu Shuang, Li Yuanjie, Liu Hongyu, Zhao Manlin, Xu Yang, Chen Yunyu, Chen Yang, Lip Gregory Y H
Department of Nephrology, China-Japan Friendship Hospital, Beijing 100029, China.
National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China.
J Clin Med. 2025 Aug 25;14(17):6008. doi: 10.3390/jcm14176008.
Cardiovascular-kidney-metabolic syndrome (CKM) represents a multisystem condition involving obesity, diabetes, chronic kidney disease, and cardiovascular diseases. Frailty, as measured by the Frailty Index (FI), is linked to adverse outcomes, but its association with CKM severity and mortality remains unclear. This study aimed to evaluate the relationship between frailty status, CKM staging, and mortality risk. We analysed data from 19,407 adults aged ≥ 45 years from NHANES 1999-2018. Frailty status was assessed using a 49-item Frailty Index (FI) and categorised as robust (FI ≤ 0.08), pre-frail (0.08 < FI < 0.25), or frail (FI ≥ 0.25). CKM was staged from 1 to 4 based on established clinical criteria. Multinomial logistic regression assessed the association between frailty status and CKM staging. Cox proportional hazards models evaluated the associations between frailty status and all-cause, cardiovascular, and non-cardiovascular mortality among CKM patients. A total of 19,407 participants (median [IQR] age: 63.00 [54.00-72.00] years, 50.77% male), with 19,089 CKM patients. Frail individuals exhibited significantly higher odds of being assigned to advanced CKM stages. Over a median follow-up of 8.4 years, 4794 participants died. Kaplan-Meier curves and restricted cubic spline analyses demonstrated a clear gradient in mortality risk across frailty categories. Compared with the robust group, pre-frail and frail individuals had significantly higher risks of all-cause (HR = 1.47 and 2.83, respectively), cardiovascular (HR = 1.71 and 3.78), and non-cardiovascular mortality (HR = 1.40 and 2.57). Frailty status demonstrated a significant association with CKM staging and mortality outcomes. Early identification of frailty may help guide risk stratification and inform tailored interventions for individuals with CKM.
心血管-肾脏-代谢综合征（CKM）是一种涉及肥胖、糖尿病、慢性肾脏病和心血管疾病的多系统病症。通过衰弱指数（FI）衡量的衰弱与不良结局相关，但其与CKM严重程度和死亡率的关联仍不明确。本研究旨在评估衰弱状态、CKM分期和死亡风险之间的关系。我们分析了1999年至2018年美国国家健康与营养检查调查（NHANES）中19407名年龄≥45岁成年人的数据。使用包含49个项目的衰弱指数（FI）评估衰弱状态，并将其分类为健康（FI≤0.08）、衰弱前期（0.08＜FI＜0.25）或衰弱（FI≥0.25）。根据既定临床标准将CKM分为1至4期。多项逻辑回归分析评估衰弱状态与CKM分期之间的关联。Cox比例风险模型评估CKM患者中衰弱状态与全因、心血管和非心血管死亡率之间的关联。共有19407名参与者（年龄中位数[四分位间距]：63.00[54.00 - 72.00]岁，50.77%为男性），其中有19089名CKM患者。衰弱个体被分配到晚期CKM分期的几率显著更高。在中位随访8.4年期间，4794名参与者死亡。Kaplan-Meier曲线和受限立方样条分析表明，不同衰弱类别之间的死亡风险存在明显梯度。与健康组相比，衰弱前期和衰弱个体的全因死亡风险（分别为HR = 1.47和2.83）、心血管死亡风险（HR = 1.71和3.78）以及非心血管死亡风险（HR = 1.40和2.57）显著更高。衰弱状态与CKM分期和死亡结局显著相关。早期识别衰弱可能有助于指导风险分层，并为CKM患者制定个性化干预措施提供依据。
