衰弱增加慢性阻塞性肺疾病急性加重期老年患者院内死亡风险:一项真实世界研究  

Frailty increases the risk of in-hospital mortality in older patients with acute exacerbation of chronic obstructive pulmonary disease:a real-world study

作　　者：李莉[1] 王蕾[2] 张丽[2] 赵重阳 汪琴 刘影[2] 刘蕾[2] 袁立姗 冯敏[2] 王刚[2] 康德英[1,3] 张欣[2] LI Li;WANG Lei;ZHANG Li;ZHAO Chongyang;WANG Qin;LIU Ying;LIU Lei;YUAN Lishan;FENG Min;WANG Gang;KANG Deying;ZHANG Xin(Department of Evidence-based Medicine and Clinical Epidemiology,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;Division of Internal Medicine,Institute of Integrated Traditional Chinese and Western Medicine,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;Center of Biostatistics,Design,Measurement and Evaluation(CBDME),Department of Clinical Research Management,West China Hospital,Sichuan University,Chengdu 610041,P.R.China)

机构地区：[1]四川大学华西医院中国循证医学中心,国家老年疾病临床医学研究中心,成都610041 [2]四川大学华西医院中西医结合内科,成都610041 [3]四川大学华西医院临床研究管理部方案设计与统计办公室,成都610041

出　　处：《中国循证医学杂志》2024年第6期652-657,共6页Chinese Journal of Evidence-based Medicine

基　　金：四川省自然科学基金青年科学基金项目(编号:2022NSFSC1278);四川大学华西医院学科卓越发展1·3·5工程项目(编号:ZYGD23002、2023HXFH045);国家老年疾病临床医学研究中心(四川大学华西医院)立项资助课题(编号:Z20192005)。

摘　　要：目的探讨衰弱对老年慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者院内死亡的影响。方法选取2022年6月至2022年12月某大型三甲医院AECOPD老年住院患者,通过多元Logistic回归分析确定包括衰弱状态在内的独立预后因素,采用中介效应分析评估C反应蛋白(C-reactive protein,CRP)和白蛋白与院内死亡之间的介导关系。结果共纳入1356例患者(年龄为86.7±6.6岁),其中25.0%患者被诊断为衰弱。通过多元Logistic回归分析发现:衰弱、平均动脉压、查尔森共病指数、中性粒细胞-淋巴细胞比率、白细胞介素6、CRP、白蛋白和肌钙蛋白T与AECOPD患者院内死亡存在相关。此外,CRP和白蛋白在衰弱与院内死亡之间的关联中发挥了中介作用。结论衰弱可能是老年AECOPD患者的不良预后因素。CRP和白蛋白可能介导了衰弱与院内死亡之间的作用机制。Objective To explore the association between frailty and in-hospital mortality in older patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods Elderly patients who were hospitalized with AECOPD from June 2022 to December 2022 at a large tertiary hospital were selected.The independent prognostic factors including frailty status were determined by multivariate logistic regression analysis.Mediation effect analysis was used to evaluate the mediating relationships between C-reactive protein(CRP)and albumin and in-hospital death.Results The training set included 1356 patients(aged 86.7±6.6),25.0%of whom were diagnosed with frailty.The multiple logistic regression analysis showed that frailty,mean arterial pressure,Charlson comorbidity index,neutrophil–lymphocyte ratio,interleukin-6,CRP,albumin,and troponin T were associated with in-hospital mortality.Furthermore,CRP and albumin mediated the associations between frailty and in-hospital mortality.Conclusion Frailty may be an adverse prognostic factor for older patients admitted with an AECOPD.CRP and albumin may be parts of mechanism between frailty and in-hospital death.

关 键 词：急性加重期慢性阻塞性肺疾病 衰弱 院内死亡率 C反应蛋白 白蛋白 真实世界研究 

分 类 号：R563.9[医药卫生—呼吸系统]