老年功能受损风险简易预测模型构建

A simple prediction model for risk of functional impairment in elderly

目的:构建老年功能受损风险预测模型。方法:选取2019年12月至2020年12月间入住上海交通大学医学院附属瑞金医院等4所三级甲等医院的住院老年患者共481例,收集基本资料、共病情况、老年综合征、检验结果等,根据国际功能、残疾和健康分类(International Classification of Functioning,Disability and Health,ICF)及功能受损评估量表(function impairment screening tool,FIST)评估,共231例患者存在功能受损。采用最小绝对收缩和选择算子(least absolute shrinkage and selection operator,LASSO)及Logistic回归筛选预测因素,构建Nomogram图。采用校准曲线、决策分析曲线、一致性指数(concordance index,C指数)等进行评价。结果:筛选并纳入年龄段、性别、社交活动、脑卒中、糖尿病、焦虑、认知障碍、衰弱、白蛋白共9项预测因素构建老年功能受损Nomogram图,校准曲线和决策分析曲线验证模型具有良好的预测能力和临床效益。C指数=0.938[95%置信区间(confidence interval,CI)=0.917~0.959]提示区分度良好。结论:本研究建立的老年功能受损Nomogram图具有良好的预测能力、临床效益和区分性,可简易快速评估老年功能受损风险,为临床预测老年功能受损提供了直观有效的指导工具。

Objective The main objective was to construct a risk prediction model of functional impairment in the elderly.Methods A total of 481 elderly patients who were admitted to four tertiary hospitals,including Shanghai Ruijin Hospital,from December in 2019 to December in 2020 were enrolled.The basic information,comorbidities,geriatric syndrome,and test results were collected.The functional impairment in 231 patients were assessed.LASSO and Logistic regression were adopted to screen predictors and construct a Nomogram.The calibration curve,decision analysis curve and concordance index(C index)were used for evaluation.Results Nine predictors including age group,gender,social activity,stroke,diabetes,anxiety,cognitive impairment,frailty and albumin were screened to construct a nomogram of impaired function in the elderly,and the calibration curve and decision analysis curve were used to validate the model,which indicated good predictive performance and clinical benefit.C index=0.938[95%confidence interval(CI)=0.917-0.959]showed good discrimination.Conclusions The Nomogram established in the study has shown good predictive ability,clinical benefit and differentiation,which can be used easily and quickly to assess the risk of functional impairment in the elderly and provide an intuitive and effective guidance tool for clinical prediction of functional impairment in the elderly.