目的:目的是预测使用脆弱,由脆弱指数(FI)定义,用于预测长期住院期间50岁及以上血管性认知障碍(VCI)患者的复发性肺炎和死亡。
方法:这项回顾性队列研究在中国西部某教学医院进行,纳入年龄≥50岁长期住院的VCI患者。从电子病历系统收集相关数据。FI基于31个参数,组使用截止值(0.2)定义为稳健(FI<0.2)和FRAIL(≥0.2)。复发性肺炎的定义是一年内至少发作两次,有症状,标志,肺炎的影像学结果在发作之间完全消失,和七天的最小间隔。由于心脏和呼吸骤停,医院记录了死亡,生存率定义为入院和确认死亡之间的间隔。Logistic回归模型用于评估FI与反复肺炎之间的关系。而FI和死亡之间的关联通过Cox比例风险模型进行评估.
结果:共纳入252例年龄≥50岁的长期住院VCI患者,其中男性115人(45.6%)。97例患者(38.5%)被定义为FRAIL。住院患者的中位住院时间为37个月。总的来说,215名患者在住院期间出现肺炎,入院后平均14.5个月,151人(59.9%)患有复发性肺炎,155人(61.5%)死亡。其中,143人在医院死亡,12人出院后死亡。FRAIL和长期住院的VCI患者之间复发性肺炎的发生率没有显着差异(FRAIL与健壮:66.0%与56.1%,P=0.121),而FRAIL患者的死亡率高于健壮患者(FRAILvs.健壮:71.1%与55.5%,P=0.013)。在进一步的Cox回归分析和调整可能的混杂因素后,在单变量分析中发现显著(包括年龄,性别,吸烟史,和日常生活活动(ADL)评分),FRAIL患者的死亡风险高于健康患者(HR=1.595,95%CI:1.149-2.213)。此外,基于模型2,在单变量分析中没有统计学意义但可能对结果产生影响的混杂变量(包括婚姻状况,教育水平,饮酒史,合并症和康复治疗)被纳入模型3进行进一步校正。结果保持不变,即,与健壮的患者相比,FRAIL患者的死亡风险较高(HR=1.771,95%CI:1.228-2.554)。
结论:在50岁或以上的长期住院VCI患者中,FI定义的虚弱可有效预测死亡风险,但不能预测复发肺炎风险。
OBJECTIVE: The aim was to predict the effectiveness of using frailty, defined by the frailty index (FI), for predicting recurrent pneumonia and death in patients over 50 years and older with vascular cognitive impairment (VCI) during long-term hospitalization.
METHODS: This retrospective cohort study was conducted at a teaching hospital in western
China and included VCI patients aged ≥50 years undergoing long-term hospitalization. The relevant data were collected from the electronic medical record system. The FI was based on 31 parameters and groups were defined using a cutoff value (0.2) as robust (FI < 0.2) and FRAIL (≥0.2). The definition of recurrent pneumonia was a minimum of two episodes within a year, with the symptoms, signs, and imaging results of pneumonia disappearing completely between episodes, and a minimum interval between episodes of seven days. Death was recorded by the hospital as the result of cardiac and respiratory arrest and survival was defined as the interval between hospital admission and confirmed death. Logistic regression models were used to assess the association between FI and recurrent pneumonia, while associations between FI and death were assessed by Cox proportional hazards models.
RESULTS: A total of 252 long-term hospitalized VCI patients ≥50 years old were enrolled, of whom 115 were male (45.6 %). Ninety-seven patients (38.5 %) were defined as FRAIL. The median length of stay for hospitalized patients was 37 months. Overall, 215 patients developed pneumonia during hospitalization, which occurred an average of 14.5 months after admission, while 151 (59.9 %) had recurrent pneumonia, and 155 (61.5 %) died. Of these, 143 died in the hospital and 12 died after discharge. No significant differences were seen in the incidence of recurrent pneumonia between FRAIL and robust long-term hospitalized VCI patients (FRAIL vs. robust: 66.0 % vs. 56.1 %, P = 0.121) while FRAIL patients had a higher mortality rate than robust patients (FRAIL vs. robust: 71.1 % vs. 55.5 %, P = 0.013). After further Cox regression analysis and adjustment for possible confounders found to be significant in the univariate analysis (including age, sex, smoking history, and activities of daily living (ADL) score), FRAIL patients had a higher risk of death than healthy patients (HR = 1.595, 95 % CI: 1.149-2.213). In addition, based on Model 2, confounding variables that were not statistically significant in the univariate analysis but may have had an impact on the results (including marital status, educational level, drinking history, comorbidity and rehabilitation treatment) were incorporated into Model 3 for further correction. The result remained unchanged, namely, that compared with robust patients, FRAIL patients had a higher risk of death (HR = 1.771, 95 % CI: 1.228-2.554).
CONCLUSIONS: Frailty defined by the FI was effective for predicting the risk of mortality but not that of recurrent pneumonia in long-term hospitalized VCI patients aged 50 or older.