三种衰弱筛查量表对急诊科老年患者预后预测效能的比较  

Comparison of the prognostic predictive efficacy of three frailty screening scales in elderly patients in the emergency department

作　　者：刘慧珍[1] 王国栋[2] 商永 商娜 李俊玉 王娜[1] 刘小蒙 郭树彬[4] 马素霞 Liu Huizhen;Wang Guodong;Shang Yong;Shang Na;Li Junyu;Wang Na;Liu Xiaomeng;Guo Shubin;Ma Suxia(Department of Emergency Medicine,Beijing Bo'Ai Hospital,China Rehabilitation Research Center,Capital Medical University School of Rehabilitation Medicine,Beijing 100068,China;Cardiovascular Department,Beijing Bo'Ai Hospital,China Rehabilitation Research Center,Capital Medical University School of Rehabilitation Medicine,Beijing 100068,China;Respiratory Department,Baoding Rehabilitation Hospital,Baoding 071051,China;Emergency Medicine Clinical Center,Beijing Chao-Yang Hospital,Capital Medical University,Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation,Beijing 100020,China;Department of Emergency Medicine,Shijingshan Teaching Hospital of Capital Medical University,Beijing Shijingshan Hospital,Beijing 100043,China)

机构地区：[1]首都医科大学康复医学院,中国康复研究中心北京博爱医院急诊科,北京100068 [2]首都医科大学康复医学院,中国康复研究中心北京博爱医院心血管内科,北京100068 [3]保定市康复医院呼吸内科,保定071051 [4]首都医科大学附属北京朝阳医院急诊医学中心,心肺脑复苏北京市重点实验室,北京100020 [5]首都医科大学石景山教学医院北京市石景山医院急诊科,北京100043

出　　处：《中华急诊医学杂志》2025年第1期55-61,共7页Chinese Journal of Emergency Medicine

基　　金：中国残联课题(2023CDPFAT-14);中国康复研究中心科研项目(2023ZX-23)。

摘　　要：目的研究衰弱与急诊科老年患者预后的相关性,验证适用急诊科的衰弱筛查工具。方法本研究为前瞻性队列研究,收集2021年1月至12月于北京博爱医院急诊科治疗的60岁及以上患者的临床资料。纳入研究的患者进行衰弱筛查问卷(frailty screening questionnaire,FSQ)、衰弱(FRAIL)、临床衰弱量表(clinical frailty scale,CFS)评分,并分别依据上述标准将患者分为衰弱组、无衰弱组。随访患者12个月全因死亡作为主要观察终点,12个月内失能、再次发生急诊为次要观察终点。采用受试者工作特征曲线评价FSQ、FRAIL、CFS评分对终点事件的预测能力,计算并比较曲线下面积(the areas under curve,AUC)。采用Cox风险比例回归模型进行生存分析,相对危险度用风险比(hazard ratio,HR)和95%CI表示。结果共406例患者纳入本研究。FSQ、FRAIL、CFS评分预测12个月全因死亡的AUC(95%CI)依次为0.879(0.844~0.909)、0.838(0.798~0.872)、0.906(0.873~0.933)(均P<0.001);3种评分预测次要终点的AUC范围为0.820~0.889(均P<0.001)。AUC两两比较结果提示,除12个月内再次发生急诊这一结局的预测效能三种方式差异无统计学意义外,CFS对12个月内全因死亡和失能结局的预测效能优于另外一种或两种量表(均P<0.05)。Cox回归发现,调整性别、年龄、身体质量指数、共患病后,FSQ、FRAIL、CFS量表定义的衰弱均与12个月全因死亡呈独立相关,HRadj分别为3.267(95%CI:2.406~4.435)、2.465(95%CI:1.819~3.341)、3.523(95%CI:2.648~4.687),均P<0.001。结论FSQ、FRAIL和CFS评分三种工具均能预测不良结局,CFS是急诊科实用的衰弱筛查工具,开展衰弱筛查,可改善老年患者的危险分层。Objective To investigate the association between frailty and prognosis of elderly patients in the emergency department,and to validate frailty screening tools suitable for the emergency department.Methods This was a prospective cohort study.Clinical data of elderly patients over 60 years old treated in the emergency department of Beijing Bo'Ai Hospital from January to December 2021 were collected.The Frailty Screening Questionnaire(FSQ),FRAIL Scale(FRAIL)and Clinical Frailty Scale(CFS)were used to score patients,and patients were divided into frail or non-frail group according to the criteria of the above three scales.Twelve-month all-cause mortality was the primary endpoint,dependence and re-admission to the emergency department within 12 months were secondary outcomes.Receiver operating characteristic curves were used to evaluate the ability of the FSQ,FRAIL and CFS scores to predict the primary and secondary endpoints,and the areas under the curve(AUC)were calculated and compared.Survival analysis was performed using Cox hazard proportional regression model,and relative risk was expressed as hazard ratio(HR)and 95%CI.Results A total of 406 patients were included in the study.The AUCs(95%CI)of FSQ,FRAIL and CFS scores for predicting 12-month all-cause mortality were 0.879(0.844-0.909),0.838(0.798-0.872),0.906(0.873-0.933),respectively(all P<0.001).The AUCs of 3 scores for predicting secondary endpoints ranged from 0.820 to 0.889(all P<0.001).Pairwise comparisons of the AUCs showed that the CFS was superior to one or both of the other frailty screening scales in predicting 12-month all-cause mortality and dependence except for re-admission to emergency room within 12 months after discharge(all P<0.05).Cox regression analysis revealed that,after adjusting for sex,age,body mass index and comorbidities,frailty as defined by the FSQ,FRAIL,and CFS scales was independently associated with 12-month all-cause mortality,with the HRadj of 3.267(95%CI:2.406-4.435),2.465(95%CI:1.819-3.341),3.523(95%CI:2.648-4.687),respectiv

关 键 词：衰弱筛查 急诊科 老年 预后 预测效能 

分 类 号：R47[医药卫生—护理学]