改良衰弱指数与老年患者非心肺转流冠状动脉搭桥手术预后的相关性

Association between modified frailty index with prognosis in elderly patients undergoing off-pump coronary artery bypass grafting

目的评估5项改良衰弱指数(mFI-5)与非心肺转流冠状动脉搭桥手术(OPCABG)老年患者预后的相关性。方法回顾性收集2019年1月至2022年5月接受OPCABG的老年患者资料,根据术前mFI-5将患者分为三组:非衰弱组(mFI-5=0分)、衰弱前期组(mFI-5=1分)和衰弱组(mFI-5≥2分)。收集三组患者的基线、术中及预后指标。采用多变量(Logistic回归及线性回归)分析评估mFI-5与OPCABG患者预后的相关性。结果共有244例患者纳入分析,其中非衰弱组35例(14.3%),衰弱前期组82例(33.6%),衰弱组127例(52.1%)。与非衰弱组比较,衰弱前期组急性肾损伤发生率明显升高(P<0.05);衰弱组术前LVEF明显降低,术中尿量明显减少,急性肾损伤发生率和死亡率明显升高(P<0.05)。与衰弱前期组比较,衰弱组术中尿量明显减少,ICU住院时间明显延长,死亡率明显升高(P<0.05)。多因素Logistic回归分析结果显示,mFI-5每升高1分,ICU住院时间延长3.189 d(95%CI 1.457~4.920 d,P<0.001),总住院时间延长2.890 d(95%CI 1.070~4.709 d,P=0.002)。线性回归分析结果显示,mFI-5升高与住院期间并发症的发生相关,包括急性肾损伤(OR=1.519,95%CI 1.076~2.145,P=0.017)、肺部并发症(OR=1.453,95%CI 1.075~1.965,P=0.015)和死亡(OR=3.730,95%CI 1.980~7.027,P<0.001)。结论mFI-5量表是一种简便实用的衰弱筛查工具,对OPCABG老年患者采用mFI-5量表进行衰弱评估,可以筛选出住院期间不良预后的高危患者。

Objective To evaluate the association between 5-factor modified frailty index(mFI-5)with prognosis in elderly patients undergoing off-pump coronary artery bypass grafting(OPCABG).Methods Retrospective data were collected from elderly patients who underwent OPCABG between January 2019 and May 2022.The patients were divided into three groups based on preoperative mFI-5:non frailty group(mFI-5=0),pre-frailty group(mFI-5=1),and frailty group(mFI-5≥2).Baseline,intraoperative,and prognostic indicators of the three groups were collected and compared.Multivariate(logistic regression and linear regression)analyses were used to evaluate the association between mFI-5 with prognosis in elderly patients undergoing OPCABG.Results A total of 244 patients were included in the analysis,including 35 patients(14.3%)in the non-frailty group,82 patients(33.6%)in the pre-frailty group,and 127 patients(52.1%)in the frailty group.Compared with the non-frailty group,the pre-frailty group had higher incidence of acute kidney injury(P<0.05);the frailty group had lower preoperative LVEF and intraoperative urine volume,and higher incidence of acute kidney injury and mortality(P<0.05).Compared with the pre-frailty group,the frailty group had lower intraoperative urine volume,prolonged ICU stay,and higher incidence of mortality(P<0.05).Multivariate logistic regression analysis showed that for every point increase in mFI-5,the length of stay in ICU was extended by 3.189 days(95%CI 1.457-4.920 days,P<0.001),and the total length of stay was extended by 2.890 days(95%CI 1.070-4.709 days,P=0.002).Linear regression analysis showed that elevated mFI-5 was associated with complications during hospitalization,including acute kidney injury(OR=1.519,95%CI 1.076-2.145,P=0.017),pulmonary complications(OR=1.453,95%CI 1.075-1.965,P=0.015)and death(OR=3.730,95%CI 1.980-7.027,P<0.001).Conclusion mFI-5 is a simple and practical screening tool for frailty,and using the mFI-5 scale for frailty assessment in elderly patients undergoing OPCABG can screen high-risk patients with poor prognosis during hospitalization.