临床易用性指标对老年慢性阻塞性肺疾病急性加重患者衰弱的预测价值

Easy-to-use indexes in predicting frailty of elderly patients with acute exacerbation of chronic obstructive pulmonary disease

目的分析老年慢性阻塞性肺疾病急性加重(AECOPD)患者合并衰弱的临床特征,探讨衰弱的预测因素。方法回顾性分析2018年7—12月在成都大学附属医院住院的80例老年AECOPD患者的临床资料,衰弱组40例,对照组40例。比较2组基本资料、相关临床检验指标及临床评分、住院时间及费用的差异,利用受试者工作特征(ROC)曲线分析阳性指标对患者衰弱风险的预测价值。结果衰弱组血清前白蛋白水平明显低于对照组[(146±55)g/L比(190±64)g/L](P=0.001)。衰弱组改良英国医学研究会呼吸困难量表(mMRC)、慢性阻塞性肺疾病评估测试(CAT)、营养风险筛查(NRS)2002评分明显高于对照组[(3.0±0.9)分比(1.9±0.7)分、(26±5)分比(18±4)分、(2.7±1.3)分比(1.9±1.3)分](均P<0.05)。衰弱组住院时间、住院总费用、日均住院费用明显高于对照组[(15±7)d比(11±6)d、(21746±15104)元比(14221±8337)元、(1469±529)元比(1185±458)元](均P<0.05)。ROC曲线分析结果显示,血清前白蛋白水平、mMRA评分、CAT评分、NRS 2002评分对预测老年AECOPD患者衰弱的敏感度分别为0.893、0.730、0.811、0.676,特异度分别为0.486、0.786、0.786、0.429,曲线下面积分别为0.706、0.810、0.852、0.656。结论老年AECOPD合并衰弱患者营养风险更高,衰弱增加住院时间及费用,血清前白蛋白水平、mMRC评分、CAT评分、NRS 2002评分对衰弱具有一定的预测意义。

Objective To analyze the clinical features of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with frailty in elderly patients and the predictive indicators of frailty.Methods Eighty elderly patients with AECOPD admitted to Affiliated Hospital of Chengdu University from July 2018 to December2018 were retrospectively analyzed.The patients were divided into frailty group and control group,with 40 cases in each group.General data,laboratory indexes and clinical scores,hospitalization time and expenses were recorded.Predictive values of relevant indicators of frailty were analyzed by receiver operating characteristic(ROC)curve.Results In frailty group there was a lower serum prealbumin level[(146±55)g/L vs(190±64)g/L](P=0.001),higherscores of modified British Medical Research Council(m MRC),Chronic Obstructive Pulmonary Disease Assessment Test(CAT)and Nutritional Risk Screening(NRS)2002,longer hospital stay,higher medical cost and daily costas compared with control group[(3.0±0.9)vs(1.9±0.7),(26±5)vs(18±4),(2.7±1.3)vs(1.9±1.3),(15±7)d vs(11±6)d,(21746±15104)yuan vs(14221±8337)yuan,(1469±529)yuan vs(1185±458)yuan](all P<0.05).ROC curve analysis showed that the sensitivities of serum prealbumin,m MRC,CAT and NRS 2002 scores in predicting frailty of AECOPD in the elderly were 0.893,0.730,0.811 and 0.676;the specificities were 0.486,0.786,0.786 and 0.429;areas under curves were0.706,0.810,0.852 and 0.656,respectively.Conclusions Frailty in elderly patients with AECOPD increases nutrition risk,hospital stay time and medical expenses.Serum prealbumin level,m MRC,CAT and NRS 2002 scores can be used for frailty assessment.