高龄老年男性共病住院患者衰弱患病情况及相关因素分析

Frailty evaluation and associated factors for oldest-old male inpatients with comorbidities: A cross-sectional study

背景衰弱指老年人生理储备下降导致的机体易损性增加、抗应激能力减退的非特异性状态,老年衰弱患者住院期间发生跌倒、感染、住院时间延长、死亡等不良事件的风险增加。目的 评估高龄老年男性住院患者的衰弱状态,探索其衰弱的相关因素。方法 收集2019年1月-2020年1月在解放军总医院第二医学中心住院的年龄≥80岁男性患者的临床资料,采用Fried衰弱表型量表评估后分为衰弱组和非衰弱组。进行单因素和多因素logistic回归分析衰弱的关联因素。结果 本研究共纳入133例患者,平均年龄(90.22±5.37)岁,老年慢性疾病中位患病数为2(2,3)种。经Fried量表评分纳入衰弱组77例(57.89%),非衰弱组56例(42.11%)。单因素分析结果显示,衰弱组年龄、总铁结合力(total iron binding capacity,TIBC)、中重度贫血、慢性肺病、癌症的构成比均显著高于非衰弱组(P <0.05),其中中重度贫血患者的衰弱患病率高达81.5%。多因素logistic回归分析显示,增龄(OR=1.151,95%CI:1.052~1.260)、高TIBC水平(OR=1.038,95%CI:1.003~1.074)、中重度贫血(OR=5.975,95%CI:1.112~32.093)是衰弱的关联因素(P <0.05),且中重度贫血与TIBC衰弱风险具有乘性交互作用(P <0.05)。根据多因素logistic回归模型,拟合中重度贫血、TIBC水平和年龄的受试者工作特征曲线,曲线下面积为0.820,且拟合度良好(χ2=10.244,P=0.248),高于中重度贫血(AUC=0.597)和TIBC(AUC=0.619)单独预测衰弱的曲线下面积。结论 高龄、中重度贫血和TIBC增高与男性老年共病发生衰弱密切相关,及时有效干预可能有助于衰弱的防控。

Background Frailty refers to the non-specific state that the decline of physiological reserves of the elderly leads to the increase of vulnerability and the decline of anti-stress ability. The risk of adverse events such as falls, infection, prolonged hospitalization and death in the elderly patients with frailty increases during hospitalization. Objective To evaluate the frail state of elderly male inpatients and explore its related factors. Methods Clinical data about male patients aged ≥ 80 years who were continuously hospitalized in the Department of Geriatrics of Chinese PLA General Hospital from January 2019 to January 2020 were collected. They were divided into frail group and non-frail group based on the evaluation by Fried Frailty Phenotype Scale.Univariate and multivariate logistic regression analyses of risk factors related with frailty were conducted. Results Totally 133 elderly patients were included with an average age of(90.22 ± 5.37) years and a median of 2(2, 3) kinds of elderly chronic diseases.There were 77(57.89%) patients in the frail group and 56(42.11%) patients in the non-frail group according to the Fried Frailty Phenotype Scale. Univariate analysis showed that age, total iron binding capacity(TIBC), and the risks of moderate-severe anemia,chronic lung disease, and cancer in the frail group were significantly higher than those in the non-frail group(all P<0.05), and the rate of moderate-severe anemia was as high as 81.5%. Multivariate logistic regression analysis showed that older age(OR=1.151,95% CI: 1.052-1.260), high TIBC level(OR=1.038, 95% CI: 1.003-1.074), and moderate-severe anemia(OR=5.975, 95% CI: 1.112-32.093) were associated with frailty(all P<0.05);multiplicative interaction was found between moderate-severe anemia and TIBC(P<0.05). Based on the multivariate logistic regression model, the receiver operating characteristic curve(ROC) was constructed,and the area under the curve(AUC) of the combination of moderate-severe anemia, TIBC level and age was 0.820, higher than that of anemia(AUC=0.597) and TIBC(AUC=0.619). Conclusion Advanced age, moderate-severe anemia, and increased TIBC are closely related to comorbidities and frailty in elderly males. Early and effective intervention will help to prevent and control the development of frailty.