Abstract：
OBJECTIVE: This study aims to evaluate the impact of frailty on the outcomes of older patients with pulmonary embolism (PE).
METHODS: Using the National Inpatient Sample database, we identified 288 070 patients aged 65 or older who were admitted with a primary diagnosis of PE from 2017 to 2019. Frailty was assessed using the Hospital Frailty Risk Score (HFRS), and patients were categorized into low-, intermediate-, and high-frailty-risk groups. Multivariate logistic regression was used to calculate adjusted odds ratios for all outcomes.
RESULTS: These patients were categorized into low-risk (57.6%, 161 420), medium-risk (39.9%, 111 805), and high-risk (2.5%, 7075) groups. High-risk patients, predominantly females with multiple comorbidities, exhibited significantly higher mortality rates and adverse outcomes. The HFRS showed a good discriminating ability in predicting mortality (area under the receiver operating characteristic curve = 0.7796). Frailty was associated with increased use of advanced therapeutic interventions and critical care resources such as thrombolysis, catheter-directed therapies, inferior vena cava filter placement, mechanical ventilation, vasopressor use, and intensive care unit admission.
CONCLUSIONS: Frailty markedly affects outcomes in older PE patients. The HFRS offers a valuable prognostic tool in this population, suggesting that integrating frailty assessments into clinical practice could enhance care strategies and improve patient outcomes. Our findings underscore the need for further research to refine frailty-based care paradigms. Geriatr Gerontol Int 2024; ••: ••-••.
METHODS: Using the National Inpatient Sample database, we identified 288 070 patients aged 65 or older who were admitted with a primary diagnosis of PE from 2017 to 2019. Frailty was assessed using the Hospital Frailty Risk Score (HFRS), and patients were categorized into low-, intermediate-, and high-frailty-risk groups. Multivariate logistic regression was used to calculate adjusted odds ratios for all outcomes.
RESULTS: These patients were categorized into low-risk (57.6%, 161 420), medium-risk (39.9%, 111 805), and high-risk (2.5%, 7075) groups. High-risk patients, predominantly females with multiple comorbidities, exhibited significantly higher mortality rates and adverse outcomes. The HFRS showed a good discriminating ability in predicting mortality (area under the receiver operating characteristic curve = 0.7796). Frailty was associated with increased use of advanced therapeutic interventions and critical care resources such as thrombolysis, catheter-directed therapies, inferior vena cava filter placement, mechanical ventilation, vasopressor use, and intensive care unit admission.
CONCLUSIONS: Frailty markedly affects outcomes in older PE patients. The HFRS offers a valuable prognostic tool in this population, suggesting that integrating frailty assessments into clinical practice could enhance care strategies and improve patient outcomes. Our findings underscore the need for further research to refine frailty-based care paradigms. Geriatr Gerontol Int 2024; ••: ••-••.
摘要：
目的：本研究旨在评估虚弱对老年肺栓塞（PE）患者预后的影响。
方法：使用全国住院患者样本数据库，从2017年至2019年,我们确定了288,070例年龄在65岁或以上的患者,这些患者主要诊断为PE.使用医院虚弱风险评分(HFRS)评估虚弱，患者被分类为低，中介-，和高危人群。使用多变量逻辑回归计算所有结果的调整后比值比。
结果：这些患者被归类为低风险（57.6％，161420)，中等风险(39.9%，111805),和高风险(2.5%，7075)组。高危患者,主要是有多种合并症的女性，表现出显著较高的死亡率和不良结局.HFRS在预测死亡率方面表现出良好的辨别能力（受试者工作特征曲线下面积=0.7796）。虚弱与高级治疗干预措施和重症监护资源如溶栓的使用增加有关。导管导向疗法,下腔静脉滤器放置,机械通气,血管加压药的使用,和重症监护室入院。
结论：虚弱显著影响老年PE患者的预后。HFRS为该人群提供了有价值的预后工具，提示将虚弱评估纳入临床实践可以增强护理策略并改善患者预后.我们的发现强调了需要进一步研究以完善基于脆弱的护理范式。GeriatrGerontolInt2024；••：••-•。
方法：使用全国住院患者样本数据库，从2017年至2019年,我们确定了288,070例年龄在65岁或以上的患者,这些患者主要诊断为PE.使用医院虚弱风险评分(HFRS)评估虚弱，患者被分类为低，中介-，和高危人群。使用多变量逻辑回归计算所有结果的调整后比值比。
结果：这些患者被归类为低风险（57.6％，161420)，中等风险(39.9%，111805),和高风险(2.5%，7075)组。高危患者,主要是有多种合并症的女性，表现出显著较高的死亡率和不良结局.HFRS在预测死亡率方面表现出良好的辨别能力（受试者工作特征曲线下面积=0.7796）。虚弱与高级治疗干预措施和重症监护资源如溶栓的使用增加有关。导管导向疗法,下腔静脉滤器放置,机械通气,血管加压药的使用,和重症监护室入院。
结论：虚弱显著影响老年PE患者的预后。HFRS为该人群提供了有价值的预后工具，提示将虚弱评估纳入临床实践可以增强护理策略并改善患者预后.我们的发现强调了需要进一步研究以完善基于脆弱的护理范式。GeriatrGerontolInt2024；••：••-•。
