老年稳定性冠心病患者认知衰弱风险预测模型的建立

Development of a cognitive frailty prediction model for elderly patients with stable coronary artery disease

目的建立老年稳定性冠心病患者认知衰弱风险的列线图模型,为临床早期识别和干预提供参考。方法便利选取848例老年稳定性冠心病患者,采用自制一般资料调查表、蒙特利尔认知评估量表、临床痴呆评定量表、衰弱表型量表进行评估;Logistic回归分析确定认知衰弱的独立危险因素,同时建立认知衰弱风险列线图预测模型并进行内部验证。结果老年稳定性冠心病患者认知衰弱发生率为11.9%;Logistic回归分析显示,年龄≥70岁、每晚睡眠时间≤6 h、有糖尿病史、心力衰竭、有高血压史、每周运动次数≤5次为老年稳定性冠心病患者认知衰弱的独立危险因素(P<0.05,P<0.01);基于上述6个危险因素建立的列线图,C-index为0.835(95%CI 0.771~0.899),H-L偏差度检测χ2=9.145(P=0.103)。结论列线图模型能够有效预测老年稳定性冠心病患者认知衰弱风险,可进一步开展外部验证研究。

Objective To develop a nomogram model for predicting cognitive frailty in elderly patients with stable coronary artery disease,and to provide reference for early clinical diagnosis and intervention.Methods A total of 848 elderly patients with stable coronary artery disease were selected using convenience sampling method.A self-designed general information questionnaire,the Montreal Cognitive Assessment,Clinical Dementia Rating,and Frailty Phenotype were utilized to collect data.A multivariate logistic regression was used to determine the risk factors of cognitive frailty,then a nomogram was developed based on the regression-based coefficients and was validated internally.Results The prevalence of cognitive frailty was 11.9%.Through logistic regression,age≥70 years old,sleeping≤6 h per night,history of diabetes,comorbid heart failure,history of hypertension,and exercise≤5 days/week were selected as factors predictive of cognitive frailty(P<0.05,P<0.01).On the basis of these factors,a nomogram was created and demonstrated good predictive abilities,with C-index of 0.835(95%CI 0.771-0.899),and also Hosmer-Lemeshow test showing goodness-of-fit of the nomogram model(χ2=9.145,P=0.103).Conclusion The nomogram model can effectively predict the risk of cognitive frailty in elderly patients with stable coronary heart disease and needs to be externally validated in further study.