年龄校正查尔森合并症指数对痴呆患者的预后评估价值

The prognostic value of age-adjusted Charlson comorbidity index in patients with dementia

目的探讨年龄校正查尔森合并症指数(ACCI)与痴呆患者预后的关系。方法回顾性分析中山市某三甲医院2018年1月至2023年7月收治的痴呆患者临床资料,整理患者合并症情况及预后情况,统计ACCI评分并进行分级,采用受试者工作特征曲线评估其对痴呆患者预后的预测能力。结果共纳入993例痴呆患者,平均年龄(79.67±8.21)岁,死亡患者159例(16%)。合并症中排名前三位的分别为脑血管疾病291例(29.3%)、慢性肺疾病289例(29.1%)、不伴器官损害的糖尿病280例(28.2%);有手术史及癫痫史的患者ACCI分级之间存在统计学差异(P<0.05),不同年龄、性别、痴呆分型以及抑郁患者ACCI分级之间不存在统计学差异(P>0.05);多因素Cox回归分析显示ACCI评分及抑郁是痴呆患者预后的独立预测因素(P<0.05);ACCI得分高危患者的死亡风险是低危患者的3.313倍(HR=3.313,95%CI为1.037~10.582);极高危患者的死亡风险是低危患者的13.154倍(HR=13.154,95%CI为4.033~43.901);ACCI评分预测痴呆患者全因死亡风险的ROC曲线下面积为0.769,对死亡风险预测有一定价值。结论痴呆患者普遍存在多种合并症,ACCI评分与痴呆患者预后相关,分数越高,患者的预后越差。

Objective To explore the relationship between age-adjusted Charlson co-morbidity index(ACCI)and the prognosis of patients with dementia.Methods A retrospective analysis of the clinical data of dementia patients admitted to a tertiary hospital in Zhongshan city from January 2018 to July 2023 was conducted.The patients comorbidities and prognosis were organized,and the ACCI scores were calculated and categorized.The predictive ability of ACCI for the prognosis of dementia patients was assessed using the receiver operating characteristic(ROC)curve.Results A total of 993 patients with dementia were included,with an average age of(79.67±8.21)years,and 159 patients(16%)died.The top three comorbidities were cerebrovascular disease in 291 cases(29.3%),chronic pulmonary disease in 289 cases(29.1%),and diabetes without organ damage in 280 cases(28.2%),whereas no statistical difference were observed between different age groups,genders,types of dementia,or levels of depression(P>0.05).Multivariate Cox regression analysis showed that ACCI score and depression were independent predictors of prognosis in patients with dementia(P<0.05).The death risk of patients with a high ACCI score was 3.313 times higher than that patients with a low score(HR=3.313,95%CI=1.037~10.582),and the death risk of patients with an extremely high score was 13.154 times higher than that of patients with a low score(HR=13.154,95%CI=4.033~43.901).The area under the ROC curve of ACCI in predicting all-cause mortality risk in patients with dementia was 0.769,indicating a certain predictive value for mortality risk.Conclusions Dementia patients generally have multiple complications,and the ACCI score is associated with their prognosis.The higher the ACCI score,the worse the prognosis of patients.