衰弱指数对老年心力衰竭患者预后的评估

Application of frailty index in evaluating the outcome of elderly HF patients

目的用衰弱指数(FI)评估老年心力衰竭(心衰)患者的预后。方法选择昆明市第二人民医院住院治疗的老年心衰患者322例,其中NYHA分级Ⅱ级150例、Ⅲ级120例、Ⅳ级52例。根据FRAIL量表评分评估衰弱状况,并分为非衰弱组165例和衰弱组157例(48.8%)。收集患者临床资料,随访1年,记录患者死亡和再住院情况,用多因素Cox比例风险回归模型分析再住院和死亡的影响因素。结果与非衰弱组比较,衰弱组年龄更高、女性比例和合并症数量更多;体质量指数、白蛋白、血红蛋白水平更低(P=0.00)。衰弱组FI明显高于非衰弱组(0.192±0.031 vs 0.125±0.031,P=0.00)。Ⅲ级FI高于Ⅱ级,Ⅳ级FI高于Ⅲ级和Ⅱ级(P<0.05)。多因素Cox分析显示,FI升高是患者死亡和再住院的危险因素(HR=3.204,P<0.05;HR=5.243,P<0.01)。结论FI可能对老年心衰患者出院后1年内死亡和再住院风险有预测价值。

Objective To study the application of frailty index(FI)in evaluating the outcome of elderly HF patients.Methods Three hundred and twenty-two hospitalized elderly HF patients were divided into NYHAⅡ(n=150),NYHAⅢ(n=120)and NYHAⅣ(n=52).Their frailty was assessed according to their frailty scale score.The patients were further divided into frailty-free group(n=165)and frailty group(n=157).Their clinical data were recorded.The patients were followed up for 1 year,during which their death and readmission were recorded.The influencing factors of their death and readmission were analyzed by multivariate Cox proportional harzards regression analysis.Results The age was significantly older,the number of female patients and complications was significantly greater while the BMI and serum levels of albumin and hemoglobulin were significantly lower in frailty group than in frailty-free group(P=0.00).The FI was significantly higher in frailty group than in frailty-free group(0.192±0.031 vs 0.125±0.031,P=0.00)and in NYHAⅢand NYHAⅣthan in NYHAⅡ(P<0.05).Multivariate Cox proportional harzards regression analysis showed that elevated FI was an indelendent risk factor for death and readmission of patients(HR=3.204,P<0.05;HR=5.243,P<0.01).ConclusionFI can predict the death and readmission of elderly HF patients within 1 year after discharge.