摘要
目的 比较临床衰弱量表(CFS)、衰弱筛查量表(FRAIL)、衰弱表型量表(Fried)及衰弱指数(FI)四种衰弱评估工具在老年射血分数保留的心力衰竭(HFpEF)患者中的临床意义与价值.方法 单中心横断面研究.纳入2021年9月至2023年2月南京医科大学第一附属医院老年心血管科的住院患者190例,其中HFpEF组61例,非HFpEF组129例.分别使用CFS、FRAIL、Fried和FI进行衰弱评估,构建综合衰弱指数(CI)作为"金标准",比较不同工具间的一致性、敏感度、特异度和受试者工作特征曲线下面积(AUC).结果 与非HFpEF组相比,HFpEF组的年龄、心房颤动比例、N末端B型利钠肽原水平、简版老年抑郁量表(GDS-15)评分更高,吸烟史比例、体质指数、舒张压、握力、简易精神状态评价量表(MMSE)评分、微型营养评估量表(MNA-SF)评分更低(均为P＜0.05).针对同一群体,所使用的衰弱评估工具不同,衰弱的患病率也各不相同;无论使用何种评估工具,HFpEF组中衰弱的患病率均高于非HFpEF组(均为P＜0.001).在整体人群及非HFpEF组中,CFS 具有良好的敏感度(98.44％、100.00％,P＜0.001)和特异度(91.27％、94.23％,P＜0.001),AUC 分别为 0.960、0.975(P＜0.001),与 CI 之间的一致性高(Kappa 值=0.846、0.864,P＜0.001);在 HFpEF人群中,Fried具有最高的敏感度(100.00％,P＜0.001)与可接受的特异度(77.27％,P＜0.001),AUC为0.956(P＜0.001),与CI之间的一致性最高(Kappa值=0.813,P＜0.001).结论 衰弱在老年患者中十分普遍,尤其在HFpEF人群中发生率更高.在老年HFpEF人群中Fried适用性更好,在老年一般人群及非HFpEF人群中CFS更具优势.
Abstract
Objective To evaluate the clinical value of Clinical Frailty Scale(CFS),Frailty Screening Inventory(FRAIL),Fried Frailty Phenotype(Fried),and Frailty Index(FI)in frailty screening for the elderly patients with heart failure with preserved ejection fraction(HFpEF).Methods This single-center cross-sectional study included 190 elderly patients in the Department of Geriatric Cardiology of the First Affiliated Hospital of Nanjing Medical University from September 2021 to February 2023.The participants comprised 61 HFpEF patients and 129 non-HFpEF patients.Frailty assessment was performed by using CFS,FRAIL,Fried,and FI,respectively,and a composite frailty index(CI)was constructed as the"gold standard"to compare the consistency,sensitivity,specificity,and area under the receiver operating characteristic curve(AUC)among different tools.Results Compared with the non-HFpEF group,patients in the HFpEF group were older,had a higher rate of atrial fibrillation,higher level of N-terminal pro-B-type natriuretic peptide,and higher score of 15-item Geriatric Depression Scale(all P＜0.05).Moreover,the HFpEF group had a lower rate of smoking,lower body mass index,diastolic blood pressure,grip strength,Mini-Mental State Examination score and Mini-Nutritional Assessment Short-Form score(all P＜0.05).Frailty prevalence varied based on different assessment tools,with frailty being more common in patients with HFpEF than in patients with non-HFpEF(all P＜0.001).In the entire group and the non-HFpEF group,CFS demonstrated good sensitivity(98.44％,100.00％,P＜0.001)and specificity(91.27％,94.23％,P＜0.001),and the AUC was 0.960,0.975(P＜0.001),respectively.The Kappa values of CFS and CI were 0.846 and 0.864,respectively(P＜0.001).In the HFpEF group,Fried had the highest sensitivity(100.00％,P＜0.001)and acceptable specificity(77.27％,P＜0.001),and the AUC was 0.956(P＜0.001).The Kappa value of Fried and CI was 0.813(P＜0.001).Conclusions Frailty is very common among elderly patients,especially in the HFpEF patients.The Fried is more applicable in elderly HFpEF patients,while the CFS is more advantageous in general elderly patients and the non-HFpEF patients.
维普
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