电子衰弱指数在≥80岁消化道出血患者院内死亡风险评估中的应用  

Application of electronic frailty index in risk assessment of in-hospital mortality in elderly patients with gastrointestinal bleeding aged 80 and over

作　　者：张帆[1] 张秋鹂[2] 都明辉 梁耀丹 谢沂泊 王华[3] 罗庆锋[1] Zhang Fan;Zhang Qiuli;Du Minghui;Liang Yaodan;Xie Yibo;Wang Hua;Luo Qingfeng(Department of Gastroenterology,Beijing Hospital National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Dermatology,Beijing Hospital National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Cardiology,Beijing Hospital National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Respiratory,Beijing Hospital National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院消化科,国家老年医学中心,中国医学科学院老年医学研究院,北京100730 [2]北京医院皮肤科,国家老年医学中心,中国医学科学院老年医学研究院,北京100730 [3]北京医院心血管内科,国家老年医学中心,中国医学科学院老年医学研究院,北京100730 [4]北京医院信息中心,国家老年医学中心,中国医学科学院老年医学研究院,北京100730

出　　处：《中华老年医学杂志》2024年第6期704-709,共6页Chinese Journal of Geriatrics

基　　金：中国医学科学院创新工程(2021-I2M-1-050)。

摘　　要：目的:分析≥80岁消化道出血患者院内死亡的相关因素,探讨电子衰弱指数(eFI)预测消化道出血患者院内死亡风险的价值。方法:回顾性分析2013年7月至2019年9月在北京医院住院的≥80岁消化道出血患者624例,根据出院转归分为死亡组和存活组,基于住院电子病历中的数据,使用累计缺陷模型构建eFI,分析发生院内死亡患者的临床特征及相关危险因素。采用受试者工作特征曲线(ROC)的曲线下面积(AUC)评估eFI对高龄消化道出血患者院内死亡的预测价值。结果:624例患者,年龄80~102(83.0±6.4)岁,男性339例,eFI≥0.15患者共581例(93.1%)。与存活组(380例)比较,死亡组(244例)患者eFI更高(0.39±0.09比0.29±0.11,t=-11.452,P<0.001),合并心力衰竭、慢性肾脏病、恶性肿瘤者的比例更高,体质指数、血红蛋白、白蛋白、总胆固醇水平更低,丙氨酸氨基转移酶、D-二聚体水平更高(均P<0.05)。Logistic回归分析结果显示,eFI(OR=2.322,95%CI:1.840~2.929,P<0.001)、恶性肿瘤(OR=1.833,95%CI:1.141~2.860,P<0.001)、白蛋白<35 g/L(OR=1.826,95%CI:1.200~2.777,P<0.001)均为≥80岁消化道出血患者院内死亡的独立相关因素,eFI每升高0.1,院内死亡风险增加1.322倍。eFI识别住院死亡的AUC为0.751(95%CI:0.713~0.789,P<0.001),eFI≥0.33预测高龄消化道出血患者住院死亡的敏感度和特异度分别为77.9%和60.3%。结论:eFI是≥80岁消化道出血患者院内死亡的独立相关因素,可用于高龄老年消化道出血患者的预后评估。Objective To investigate the factors contributing to in-hospital mortality among elderly patients aged 80 and above with gastrointestinal bleeding(GIB).Additionally,it seeks to assess the predictive ability of the electronic frailty index(eFI)in determining the risk of in-hospital mortality in GIB patients.Methods A retrospective analysis was performed among 624 patients aged 80 and above with GIB who were admitted to Beijing Hospital between July 2013 and September 2019.The patients were categorized into two groups based on their discharge outcomes:those who survived and those who did not.The eFI was developed using a cumulative deficit model utilizing data from the hospital's electronic medical records.The study examined the clinical features and risk factors associated with in-hospital mortality among these elderly patients.The effectiveness of eFI in predicting in-hospital mortality in elderly patients with gastrointestinal bleeding was evaluated by calculating the area under the curve(AUC)of the receiver operating characteristic(ROC)curve.Results Among a total of 624 patients aged between 80 and 102 years,the average age was(83.0±6.4)years,with 339 being male.A majority of the patients,581 cases(93.1%),had an eFI≥0.15.A comparison between the survival group(380 cases)and the death group(244 cases)revealed that the latter had higher eFI values(0.39±0.09 vs.0.29±0.11,t=-11.452,P<0.001),along with higher rates of heart failure,chronic kidney disease,and malignant tumors,as well as lower body mass index,hemoglobin,albumin,and total cholesterol levels,and higher alanine aminotransferase and D-dimer levels(all P<0.05).Logistic regression analysis indicated that eFI(OR=2.322,95%CI:1.840-2.929,P<0.001),malignant tumor(OR=1.833,95%CI:1.141-2.860,P<0.001),and albumin<35 g/L(OR=1.826,95%CI:1.200-2.777,P<0.001)were independent risk factors for in-hospital death in elderly patients aged 80 and over with gastrointestinal bleeding.With every 0.1 increase in eFI,the risk of in-hospital death rose by 1.322 times.The AUC

关 键 词：胃肠出血 死亡 危险性评估 衰弱 

分 类 号：R573.2[医药卫生—消化系统]