不同衰弱评估工具对老年住院患者出院后不良事件的预测效果比较

Comparison of predictability on adverse events among different assessment tools in elderly discharged inpatients

目的探讨衰弱表型评估(frailty phenotype,FP)、衰弱量表(frail scale,FS)、临床衰弱量表(clinical frailty scale,CFS)3种衰弱评估工具对老年住院患者出院后不良健康事件(再住院及死亡)的预测效果,筛选出针对住院老年患者简便有效的衰弱评估工具。方法采用前瞻性队列研究方法,入选65岁及以上老年住院患者采用FP、FS和CFS分别进行衰弱评估。出院后随访6个月及以上,记录不良健康事件(再住院和死亡),采用Cox回归模型评价不同衰弱评估工具与死亡、再住院之间的关系,采用受试者工作特征曲线(ROC)比较3种衰弱评估方法对不良健康事件的预测效果。结果共入选539例老年患者,12例失访,完成随访527例,患者平均年龄(84.1±6.0)岁,其中男性占61.9%(326/527);采用FP、FS评估工具检出衰弱的患者比例分别为26.0%(137/527)、26.0%(137/527),采用CFS评估中重度衰弱比例为25.2%(133/527);在Cox回归模型中,校正了年龄、吸烟、共病状态等变量后,FP、FS及CFS评估为衰弱的老年患者较非衰弱者的死亡率均增加(HR=3.72、2.95、3.90,P=0.017、0.016、0.002),再住院Cox回归模型中应用FS及CFS评估方法,调整上述变量后,衰弱的老年患者较非衰弱者的再住院率显著增加(HR=1.81、1.69,P=0.000、0.002),FP、FS、CFS预测死亡和再住院的受试者操作特征曲线下面积(AUC)分别为0.691、0.645、0.728及0.570、0.579、0.602(均P<0.01)。结论FP、FS和CFS 3种衰弱评估方法对老年住院患者的死亡均有预测效果,CFS预测效果优于其他两种评估方法,对再住院预测效果差。

Objective To investigate the predictability on adverse events(re-hospitalization and death)in elderly discharged inpatients among frailty phenotype(FP),frail scale(FS)and clinical frailty scale(CFS),in order to screen the simple and feasible frailty assessment tools for elderly discharged inpatients.Methods Elderly discharged inpatients aged 65 years and over were recruited for this prospective cohort study.And they underwent frailty assessment by using FP,FS and CFS,respectively.Patients were followed up for more than 6 months after discharge,and adverse events including re-hospitalization or death after discharge were recorded.Cox regression model was adopted to evaluate the relationship between frailty and death or re-hospitalization.Predictive effects of three assessment methods on adverse events were compared by using receiver operating characteristic(ROC).Results A total of 527 elderly patients aged(84.1±6.0)years with males of 61.9%(326/527)were successfully followed up.The detection rate of frailty by FP and FS evaluation tools was 26.0%(137/527)and 26.0%(137/527),respectively.The detection rate of moderate and severe frailty by CFS was 25.2%(133/527).The Cox regression model showed that the mortality was significantly higher in frailty patients by FP,FS,and CFS than in the non-frailty patients(HR=3.72,2.95 and 3.90,P=0.017,0.016 and 0.002)after adjusting for age,smoking,co-morbidity and other variable;and that the re-hospitalization rate was significant higher in frailty patients by FP and CFS than in the non-frailty patients(HR=1.81 and 1.69,P=0.000 and 0.002).The areas under the receiver operating characteristic curve(AUC)of FP,FS and CFS for predicting death and re-hospitalization were 0.691,0.645,0.728 on death,and 0.570,0.579,0.602 on re-hospitalization(all P<0.01),respectively.Conclusions All three assessment tools of FP,FS and CFS have predictive effects on death in elderly inpatients with frailty,and CFS has better predictive effect than the other two tools.But FP,FS and CFS have poor predictive effect on re-hospitalization.