衰弱表型和衰弱筛查量表在老年住院患者中的应用比较

Application comparison of Frailty Phenotype and FRAIL Scale in frailty risk screening of elderly inpatients

目的比较衰弱表型和衰弱筛查量表(FRAIL量表)对老年住院患者衰弱风险的筛查能力,为临床选择合适的衰弱筛查工具提供参考。方法采用便利抽样法,选取2019年11月—2020年7月在宁夏回族自治区某三级甲等医院住院的462例老年住院患者为研究对象,采用衰弱表型、衰弱筛查量表和衰弱指数进行衰弱评价。以衰弱指数为诊断标准,通过受试者工作特征(receiver operating characteristic,ROC)曲线和Bayes判别分析比较衰弱表型和衰弱筛查量表筛查老年住院患者衰弱风险的能力。结果应用衰弱表型、衰弱筛查量表和衰弱指数筛查老年住院患者衰弱的发生率分别34.2%、25.1%和30.5%;衰弱表型和衰弱筛查量表与衰弱指数的筛查结果一致性检验Kappa值分别为0.511、0.479(均P<0.01);衰弱表型和衰弱筛查量表的ROC曲线下面积分别为0.823(95%CI:0.784~0.858)、0.853(95%CI:0.815~0.885),差异无统计学意义(Z=1.366,P=0.17);衰弱风险预测的交叉验证准确率分别为78.6%和79.0%;最佳预测值分别为3和2;灵敏度分别为0.709和0.837,特异度分别为0.817和0.790,约登指数分别为0.529和0.625,阳性预测值分别为0.697和0.702,阴性预测值分别为0.825和0.891。结论衰弱表型和衰弱筛查量表筛查老年住院患者衰弱风险的能力均为中等;衰弱筛查量表的衰弱风险预测效能更高且使用便捷,更适用于老年住院患者的衰弱风险筛查。

Objective To compare the screening ability of Frailty Phenotype and FRAIL scale for frailty risk in elderly inpatients,and to provide references for clinical selection of appropriate screening tools for frailty.Methods A total of 462 elderly inpatients in a tertiary hospital in Ningxia were selected by convenience sampling method,and the Frailty Index,Frailty Phenotype and FRAIL scale were used to score them.Taking Frailty Index as the diagnostic standard,the predictive value of the 2 scales for frailty risk was compared by the Receiver Operating Characteristic(ROC)and Bayes discriminant analysis.Results The incidences of frailty in elderly hospitalized patients by Frailty Phenotype,FRAIL and Frailty Index were 34.2%,25.1%and 30.5%,respectively.The consistency of the screening results of Frailty Phenotype,FRAIL scale and Frailty Index showed that the Kappa values are0.511,0.479(P<0.01).The Frailty Phenotype and FRAIL area under ROC curve are 0.823(95%CI:0.784~0.858)and 0.853(95%CI:0.815~0.885).The differences are not statistically significant(Z=1.366,P>0.05).The accuracy of cross-validation in the determination of frailty are 78.6%and 79.0%.The best predictive values are 3 and 2;the sensitivity is 0.709 and 0.837;the specificity is 0.817 and 0.790;the Youden indexes are 0.529 and 0.625;the positive predictive values are 0.697 and 0.702;the negative predictive values are 0.825 and 0.891.Conclusion The ability of Frailty Phenotype and FRAIL scale to screen the frailty risk of elderly inpatients is moderate.FRAIL scale is more effective in predicting the risk of frailty and more convenient to use,and it is more suitable for screening the frailty risk of the elderly inpatients.