衰弱与呼吸功能损伤重症患者预后关系的临床研究

Clinical study on the relationship between frailty and prognosis of severe patients with respiratory function injury

目的探讨衰弱与呼吸功能损伤重症患者预后的关系。方法回顾性分析2016年1月至2021年12月首都医科大学附属北京同仁医院508例呼吸功能损伤重症患者(氧分压<80 mmHg)(1 mmHg=0.133 kPa)的临床资料,根据预后将其分为存活组(431例)和死亡组(77例),收集两组基本资料,记录两组临床衰弱量表评分、急性肾衰竭情况、呼吸衰竭情况、入住呼吸重症监护病房时间,并计算入院24 h的急性生理和慢性健康状况Ⅱ(APACHEⅡ)评分(APACHEⅡ-1),经初步诊治后在48~72 h再次计算APACHEⅡ评分(APACHEⅡ-3)。比较两组各项资料并分析呼吸功能损伤重症患者预后的影响因素,并进一步分析衰弱对患者死亡的预测价值。结果死亡组年龄、APACHEⅡ-1、APACHEⅡ-3、临床衰弱量表评分及急性肾衰竭、呼吸衰竭占比均高于存活组,差异有统计学意义(P<0.05)。年龄、临床衰弱量表评分、急性肾衰竭、呼吸衰竭、APACHEⅡ-3是呼吸功能损伤重症患者预后的影响因素(P<0.05)。年龄、临床衰弱量表评分、APACHEⅡ-3联合对呼吸功能损伤重症患者预后具有中等判断能力,三者联合预测呼吸功能损伤重症患者预后的受试者操作特征曲线下面积(AUC)高于年龄、临床衰弱量表评分、APACHEⅡ-3单独预测(P<0.05),临床衰弱量表评分的AUC高于年龄(P<0.05)。结论衰弱是呼吸功能损伤重症患者预后的独立影响因素,临床衰弱量表评分可辅助预测老年呼吸功能损伤患者预后。

Objective To explore the relationship between frailty and prognosis of severe patients with respiratory function injury.Methods The clinical data of 508 severe patients with respiratory function injury(partial pressure of oxygen<80 mmHg)(1 mmHg=0.133 kPa)were retrospectively analyzed in Beijing Tongren Hospital,Capital Medical University from January 2016 to December 2021.According to the prognosis,they were divided into survival group(431 cases)and death group(77 cases).The basic data of the two groups were collected,and the clinical frailty scale score,acute renal failure,respiratory failure,and time of admission to the respiratory intensive care unit were recorded.Acute physiology and chronic health evaluationⅡ(APACHEⅡ)scores were calculated at 24 h after admission(APACHEⅡ-1),and APACHEⅡscores were calculated again at 48-72 h after initial diagnosis and treatment(APACHEⅡ-3).The data of the two groups were compared and the influencing factors of the prognosis of severe patients with respiratory function injury were analyzed and the predictive value of frailty on death of patients was futher analyzed.Results Age,APACHEⅡ-1,APACHEⅡ-3,clinical frailty scale score,and proportion of acute renal failure and respiratory failure in death group were higher than those in survival group,the differences were statistically significant(P<0.05).Age,clinical frailty scale score,acute renal failure,respiratory failure,and APACHEⅡ-3 were the influencing factors for the prognosis of severe patients with respiratory function injury(P<0.05).Age,clinical frailty scale score,and APACHEⅡ-3 combined had moderate ability to predict the prognosis of severe patients with respiratory impairment.The area under the receiver operating characteristic curve(AUC)combined with age,clinical frailty scale score,and APACHEⅡ-3 was higher than that of age,clinical frailty scale score,and APACHEⅡ-3 alone(P<0.05).The AUC of clinical frailty scale score was higher than that of age(P<0.05).Conclusion Frailty is an independent risk factor in predicting the prognosis for severe patients with respiratory impairment.Clinical frailty scale score for severe patients with respiratory impairment can assist in the evaluation of prognosis.