衰弱筛查量表与急性心力衰竭患者临床不良预后的相关性分析  

Correlation between the"FRAIL"scale and clinical adverse outcomes in patients with acute heart failure

作　　者：曹李瑶[1] 原琳[1] 陈红[1] 王冲[1] 王喜福[1] CAO Liyao;YUAN Lin;CHEN Hong;WANG Chong;LIU Shumei(Department of Emergency Medicine,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所急诊科,100029

出　　处：《心肺血管病杂志》2025年第1期24-31,共8页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京市自然科学基金(7232042)。

摘　　要：目的:本研究通过衰弱筛选量表探讨衰弱与急性心力衰竭患者预后的关系。方法:本研究纳入2018年至2020年,首都医科大学附属北京安贞医院急诊科收治的726例急性心力衰竭患者,中位随访时间2.4年。根据衰弱筛查量表(the"FRAIL"scale)将患者分为无衰弱组(n=89)、衰弱前期组(n=329)和衰弱组(n=308)。主要终点为全因死亡和心力衰竭再住院的复合终点,次要终点为全因死亡和心力衰竭再住院。采用Kaplan-Meier生存分析、多元COX回归分析、限制性立方样条(restricted cubic spline,RCS)和亚组分析评估衰弱与预后的关系。结果:衰弱组主要终点发生率(38.3%)和心力衰竭再住院率(29.2%),均显著高于衰弱前期组(23.4%vs.18.2%)和无衰弱组(11.2%vs.9.0%),差异有统计学意义(P<0.001)。多元Cox回归分析表明,与无衰弱组相比,衰弱组显著增加了患者主要终点的发生风险(HR=3.08,95%CI:1.60~5.93,P=0.001)和心力衰竭再住院的风险(HR=3.07,95%CI:1.48~6.37,P=0.003)。Kaplan-Meier曲线结果显示,衰弱患者主要终点和心力衰竭再住院发生率显著增高(Log-rank P<0.05)。RCS曲线表明随着衰弱筛查量表评分增高,患者主要终点的发生风险显著增加(非线性P=0.210)。在主要终点和心力衰竭再住院结局中,各亚组中未见显著的交互作用。结论:衰弱与急性心力衰竭患者主要不良结局发生风险增高显著相关,可作为该人群预后评估的重要指标。Objective:To investigate the relationship between frailty and prognosis in patients with acute heart failure by the"FRAIL"scale.Methods:This study included 726 patients with acute heart failure admitted to Anzhen Hospital between 2018 and 2020,with a median follow-up time of 2.4 years.Patients were divided into non-frail(n=89),pre-frail(n=329),and frail(n=308)groups based on the"FRAIL"scale.The primary endpoint was a composite of all-cause mortality and heart failure rehospitalization,and the secondary endpoints were all-cause mortality and heart failure rehospitalization.Kaplan-Meier survival analysis,restricted cubic spline(RCS),and subgroup analysis were used to evaluate the relationship between frailty and prognosis.Results:The frail group had significantly higher rates of the primary outcome(38.3%)and heart failure rehospitalization(29.2%)compared to the pre-frail group(23.4%vs.18.2%)and the non-frail group(11.2%vs.9.0%),with statistically significant differences(P<0.001).Multivariate COX regression analysis showed that,compared to the non-frail group,the frail group had a significantly increased risk of the primary endpoint(HR=3.08,95%CI:1.60-5.93,P=0.001)and heart failure rehospitalization(HR=3.07,95%CI:1.48-6.37,P=0.003).Kaplan-Meier curves showed that frail patients had significantly higher rates of the primary outcome and heart failure rehospitalization(Log-rank P<0.05).The RCS curve indicated that as the frailty scale score increased,the risk of the primary outcome significantly increased(non-linear P=0.210).No significant interactions were observed among subgroups for the primary outcome and heart failure rehospitalization.Conclusions:Frailty is significantly associated with an increased risk of major adverse outcomes in patients with acute heart failure and can serve as an important indicator for prognostic assessment in this population.

关 键 词：急性心力衰竭 衰弱筛查量表 全因死亡 心力衰竭再住院 

分 类 号：R54[医药卫生—心血管疾病]