衰弱增加慢性阻塞性肺疾病急性加重期老年患者院内死亡风险:一项真实世界研究
Frailty increases the risk of in-hospital mortality in older patients with acute exacerbation of chronic obstructive pulmonary disease:a real-world study
李莉 1王蕾 2张丽 2赵重阳 1汪琴 1刘影 2刘蕾 2袁立姗 2冯敏 2王刚 2康德英 3张欣2
作者信息
- 1. 四川大学华西医院中国循证医学中心,国家老年疾病临床医学研究中心(成都 610041)
- 2. 四川大学华西医院中西医结合内科(成都 610041)
- 3. 四川大学华西医院中国循证医学中心,国家老年疾病临床医学研究中心(成都 610041);四川大学华西医院临床研究管理部方案设计与统计办公室(成都 610041)
- 折叠
摘要
目的 探讨衰弱对老年慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者院内死亡的影响.方法 选取2022年6月至2022年12月某大型三甲医院AECOPD老年住院患者,通过多元Logistic回归分析确定包括衰弱状态在内的独立预后因素,采用中介效应分析评估C反应蛋白(C-reactive protein,CRP)和白蛋白与院内死亡之间的介导关系.结果 共纳入1 356例患者(年龄为86.7±6.6岁),其中25.0％患者被诊断为衰弱.通过多元Logistic回归分析发现:衰弱、平均动脉压、查尔森共病指数、中性粒细胞-淋巴细胞比率、白细胞介素6、CRP、白蛋白和肌钙蛋白T与AECOPD患者院内死亡存在相关.此外,CRP和白蛋白在衰弱与院内死亡之间的关联中发挥了中介作用.结论 衰弱可能是老年AECOPD患者的不良预后因素.CRP和白蛋白可能介导了衰弱与院内死亡之间的作用机制.
Abstract
Objective To explore the association between frailty and in-hospital mortality in older patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods Elderly patients who were hospitalized with AECOPD from June 2022 to December 2022 at a large tertiary hospital were selected.The independent prognostic factors including frailty status were determined by multivariate logistic regression analysis.Mediation effect analysis was used to evaluate the mediating relationships between C-reactive protein(CRP)and albumin and in-hospital death.Results The training set included 1 356 patients(aged 86.7±6.6),25.0％of whom were diagnosed with frailty.The multiple logistic regression analysis showed that frailty,mean arterial pressure,Charlson comorbidity index,neutrophil-lymphocyte ratio,interleukin-6,CRP,albumin,and troponin T were associated with in-hospital mortality.Furthermore,CRP and albumin mediated the associations between frailty and in-hospital mortality.Conclusion Frailty may be an adverse prognostic factor for older patients admitted with an AECOPD.CRP and albumin may be parts of mechanism between frailty and in-hospital death.
关键词
急性加重期慢性阻塞性肺疾病/衰弱/院内死亡率/C反应蛋白/白蛋白/真实世界研究Key words
Acute exacerbation of chronic obstructive pulmonary disease/Frailty/In-hospital mortality/C-reactive protein/Albumin/Real-world study引用本文复制引用
基金项目
四川省自然科学基金青年科学基金项目(2022NSFSC1278)
四川大学华西医院学科卓越发展1.3.5工程项目(ZYGD23002)
四川大学华西医院学科卓越发展1.3.5工程项目(2023HXFH045)
国家老年疾病临床医学研究中心(四川大学华西医院)立项资助课题(Z20192005)
出版年
2024
NETL
NSTL
万方数据