老年住院患者肌肉减少症发生的危险因素分析及预测模型建立

Risk factors analysis and nomogram prediction of sarcopenia in elderly inpatients

目的通过分析老年住院患者肌肉减少症的相关因素,建立个体化预测肌肉减少症发生风险的列线图模型。方法收集2017年1月至2018年12月青海大学附属医院全科医学科住院患者,年龄≥60岁,采用亚洲肌肉减少症工作组诊断标准进行患者的纳入,通过Logistic回归筛选出老年患者肌肉减少症发生的独立危险因素,根据独立危险因素建立预测肌肉减少症发生风险的列线图模型,使用Bootstrap法进行模型验证,使用C-index和校准曲线对预测模型的区分度及校准度进行评估。结果268例老年患者发生肌肉减少症83例,发生率为30.9%。年龄(OR=1.726,95%CI 1.244~2.432)、体质量指数(OR=0.753,95%CI 0.621~0.969)、吸烟(持续/长期)(OR=1.081,95%CI 1.048~3.297)、骨质疏松症(OR=2.031,95%CI 1.201~4.193)均是发生老年患者肌肉减少症的独立危险因素。列线图模型预测肌肉减少症发生风险的一致性指数为0.775(95%CI 0.722~0.827)。结论年龄、体质量指数、骨质疏松症和吸烟(持续/长期)这4项可能是老年患者肌肉减少症发生的独立危险因素,列线图模型可更直观地评价老年患者肌肉减少症发生的风险,有较高的临床应用价值。

Objective To establish an individualized nomogram model to predict the risk of sarcopenia by analyzing the related factors of myopenia in elderly inpatients.Methods Inpatients in the department of Affiliated Hospital of Qinghai University from January 2017 to December 2018,aged≥60 years old,were included by the diagnostic criteria of Asian sarcopenia working group,and the independent risk factors were screened by logistic regression for the occurrence of sarcopenia.According to the independent risk factors,a nomogram model was established to predict the risk of sarcopenia.Bootstrap method was used to verify the model.C-index and calibration curve were used to evaluate the differentiation and calibration of the prediction model.Results Totally 83 of 268 elderly patients had sarcopenia,the incidence was 30.9%.Age(OR=1.726,95%CI 1.244-2.432),body mass index(OR=0.753,95%CI 0.621-0.969),current smoking(OR=1.081,95%CI 1.048-3.297),osteoporosis(OR=2.031,95%CI 1.201-4.193)were all independent risk factors of myopenia in elderly patients.The concordance index for predicting the risk of myopenia was 0.775(95%CI 0.722-0.827).Conclusion Age,body mass index,osteoporosis,smoking are the independent risk factors of myopenia in elderly patients.The nomogram model can more directly evaluate the risk of sarcopenia in elderly patients.