老年住院患者步速和握力对全因死亡预测价值的比较

Comparison of gait speed and grip strength for the prediction of all-cause mortality in elderly inpatients

目的分析75岁及以上老年住院患者步速和握力与出院后死亡的关系,并比较两者对全因死亡的预测价值.方法采用前瞻性队列研究,入选2016年12月至2019年12月在首都医科大学附属复兴医院全科及老年医学科住院且年龄≥75岁的老年患者,采用6 m步行试验和握力计测量步速(m/s)和握力(kg),出院随访1年以上并记录患者的全因死亡时间,采用Cox回归模型分析步速、握力和步速联合握力与全因死亡风险的相关性.步速与握力的ROC曲线采用DeLong检验进行统计学比较.结果共入选患者704例,年龄(83.8±6.3)岁;中位随访时间33(24,42)月,随访期间共131例(18.6%)发生全因死亡.与步速未减慢及握力未下降组比较,步速减慢及握力下降组的全因死亡发生率更高(均P<0.05).采用Cox回归模型对步速和握力与全因死亡的关系进行分析,结果显示,在校正了相关因素后,步速(HR=2.255,95%CI:1.462~3.477,P<0.001)和握力(HR=1.815,95%CI:1.232~2.673,P<0.001)均与全因死亡风险相关,且与步速未减慢合并握力未下降组比较,当步速减慢同时握力下降时死亡风险最大(HR=3.156,95%CI:1.829~5.445,P<0.001).采用Delong检验对步速及握力的ROC曲线进行比较,结果显示,步速的曲线下面积(AUC)(0.703,95%CI:0.667~0.736)大于握力的AUC(0.648,95%CI:0.611~0.683),面积间差异为0.055(95%CI:0.006~0.103,P=0.026).结论步速减慢或握力下降均与死亡风险增加有关,当患者同时存在步速减慢和握力下降时,死亡风险最高;步速对死亡的预测价值优于握力,两者可以作为简便、快捷、有效的预测老年人群全因死亡的工具.

Objective To analyze the relationship between gait speed or grip strength and all-cause mortality in elderly inpatients over 75 years old,and to compare their predictive value for all-cause mortality.Methods A prospective cohort study was conducted and enrolled elderly patientsaged≥75 years hospitalized from December 2016 to December 2019 at the Department of IntegratedMedicine and Geriatries,Fuxing Hospital,Capital Medical University.Gait speed(m/s)and grip strength(kg)were respectively measured via the 6-meter walk test and a dynamometer.The patients were followed up for more than 1 year after discharge,and the time of all-cause mortality was recorded.The Cox regression model was used to analyze the correlation between gait speed,grip strength or their combination and the risk of all-cause mortality.ROC curves were statistically analyzed using the DeLong test.Results A total of 704 patients were enrolled,with an average age of(83.8±6.3)years;the median follow-up time was 33(24,42)months.During the follow-up period,all-cause death occurred in 131 cases(18.6%).Compared with the high gait speed and high grip strength groups,the low gait speed and low grip strength groups had higher all-cause mortality(all P<0.05).The Cox regression model was used to analyze the relationships between gait speed,grip strength and all-cause mortality.The results showed that gait speed(HR=2.255,95%CI:1.462-3.477,P<0.001)and grip strength(HR=1.815,95%CI:1.232-2.673.P<0.001)were associated with the risk of all-cause mortality after adjustment for other factors:When gait speed slowed down and grip strength decreased,the risk of death reached the highest level(HR=3.156,95%C1:1.829-5.445.P<0,001).The AUC of the gait speed model(0.703,95%CI:0.667-0.736)was higher than the AUC of the grip strength model(0.648.95%CI:0.611-0.683).with a difference of 0.055(95%.CI:0.006-0.103,P=0.026).Conclusions Decreased gait speed or grip strength is related to an increase of death risk.The risk of death is highest when the patient has both slowed gait speed and decreased grip strength.The predictive value of gait speed for death is better than grip strength.Together they can be used as simple,rapid and effective tools to predict all-cause mortality in this population.