Study on frailty status and the association between vitamin D nutritional status and frailty in elderly patients in emergency department
Objective To examine the prevalence of frailty among elderly patients in the emergency department and to investigate the potential relationship between vitamin D nutritional status and frailty.Methods This study collected clinical data from elderly patients aged over 65 years in the emergency intensive care unit and emergency observation ward of Beijing Bo'Ai Hospital from January to September 2021.The data included blood routine,biochemical indicators,circulating interleukin-6,cortisol,thyrotropin,and 25-hydroxyvitamin D[25(OH)D],which were detected within 24 hours after enrollment.Additionally,the Frailty Screening Questionnaire(FSQ),FRAIL scale,and Clinical Frailty Scale(CFS)were used to score the patients.Based on the scores,the patients were divided into frail or non-frail groups,and the prevalence of frailty was reported accordingly using the criteria of the aforementioned scales.The consistency of the three scales was evaluated using the Spearman rank test and Kappa coefficient.We compared the differences in clinical data and laboratory indicators of patients between the frail and non-frail groups.Additionally,we used a multivariable Logistic regression model to analyze the association between vitamin D nutritional status and frailty.We also analyzed the prevalence of frailty in different vitamin D nutritional statuses and evaluated the predictive ability of serum 25(OH)D for frailty using the receiver operating characteristic(ROC)curve.Results A total of 317 patients were included in the study.The prevalence of frailty in elderly patients in the emergency department was found to be 47.0％,55.2％,and 69.4％according to the FSQ,FRAIL,and CFS scales,respectively.The study evaluated the consistency of these three scales,revealing a Spearman rank correlation coefficient of 0.761(95％CI:0.715-0.806,P＜0.001)and a Kappa coefficient of 0.536(95％CI:0.451-0.621,P＜0.001)between FSQ and FRAIL,which were the highest correlations observed.Logistic regression analysis,after adjusting for age,gender,BMI,and other factors,indicated that vitamin D deficiency(OR=5.994,95％CI:1.232-29.169,P=0.027)was independently associated with an increased prevalence of frailty as defined by FSQ criteria.The prevalence of frailty increased with the severity of vitamin D malnutrition.In the vitamin D deficiency group,the prevalence was higher compared to the vitamin D insufficiency and sufficiency groups(P＜0.05 for all).The area under the ROC curves(AUCs)of serum 25(OH)D levels to predict frailty,as defined by FSQ,FRAIL,and CFS,were 0.806(95％CI:0.744-0.868),0.748(95％CI:0.679-0.817),and 0.768(95％CI:0.701-0.826)(P＜0.001 for all).The optimal cut-off values were 12.0,9.76,and 11.65 μg/L,respectively,yielding a Youden index of 0.553,0.419,and 0.462.Conclusions FSQ,FRAIL,and CFS demonstrated a strong level of consistency in assessing frailty.Additionally,serum 25(OH)D can serve as an independent predictor of frailty,aiding in the identification of frail individuals and enhancing the risk stratification of elderly patients in the emergency department.
NETL
NSTL
万方数据
