基于双量表评估的内科住院老年患者衰弱状况及结局预测价值对比

Comparative analysis of frailty status and predictive value for outcomes in elderly medical inpatients based on dual-scale assessment

摘要

目的：分析内科住院老年患者的衰弱状况及其影响因素，比较衰弱筛查量表（fatigue，resistance，ambulation，illnesses，loss of weight，FRAIL量表）与埃德蒙顿衰弱评估量表（Edmonton frail scale，EFS量表）对不良结局的预测价值。方法：采用前瞻性队列设计，纳入广西医科大学第一附属医院467例住院老年患者，使用FRAIL量表和EFS量表评估衰弱状态，通过单因素与多因素logistic回归分析影响因素，运用受试者工作特征（receiver operating characteristic，ROC）曲线检验两个量表对出院后3个月功能衰退（Katz指数下降）、全职照护需求及死亡的预测效能。结果：衰弱患病率为60.81%（284/467），独立危险因素包括离异/丧偶（OR=7.75～8.10）、低收入（OR=2.62～17.46）、高频住院（OR=0.94～2.38）、多重用药（OR=1.55）、有营养风险（OR=14.62）、肌力下降（OR=0.35）、跌倒高风险（OR=3.16）、跌倒次数多（OR=2.62）及睡眠不足（OR=0.58）（均 P＜0.05）。FRAIL量表对全职照护需求预测中等有效（AUC=0.636，切点3.5分），EFS对死亡风险预测高效（AUC=0.755，切点5.5分），但二者对功能衰退预测价值有限（AUC≤0.579）。结论：内科住院老年患者衰弱受多维因素影响，FRAIL量表适用于照护需求快速筛查，EFS量表更适合预测死亡风险。建议临床根据评估目的选择适配工具，并结合动态监测优化衰弱管理。

Abstract

Objective: To analyze the frailty status and its influencing factors in elderly inpatients and compare the predictive value of the fatigue, resistance, ambulation, illnesses, and loss of weight (FRAIL) scale and the Edmonton frail scale (EFS) for adverse outcomes. Methods: Based on a prospective cohort study design, 467 elderly medical inpatients were enrolled from the First Affiliated Hospital of Guangxi Medical University. Frailty status was assessed using the FRAIL scale and EFS. Influencing factors were identified through univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curves were used to evaluate the predictive efficacy of both scales for functional decline (decline in Katz index), full-time care needs, and mortality at 3 months post-discharge. Results: The incidence of frailty was 60.81% (284/467). Independent risk factors included divorce/widowhood (OR=7.75-8.10), low income (OR=2.62-17.46), frequent hospitalization (OR=0.94-2.38), polypharmacy (OR=1.55), at nutritional risk (OR=14.62), decreased muscle strength (OR=0.35), high fall risk (OR=3.16), frequent falls (OR=2.26), and insufficient sleep (OR=0.58) (all P＜0.05). The FRAIL scale demonstrated moderate predictive efficacy for full-time care needs (AUC=0.636, cutoff=3.5), while the EFS showed high predictive efficacy for mortality risk (AUC=0.755, cutoff=5.5 points). Both scales exhibited limited predictive value for functional decline (AUC≤0.579). Conclusion: Frailty status of elderly medical inpatients is influenced by multidimensional factors. The FRAIL scale is suitable for the rapid screening of care needs, while the EFS is more effective for predicting mortality risk. In clinical practice, appropriate tools should be selected according to the purpose of assessments to optimize frailty management by integrating dynamic monitoring.

关键词

住院患者 / 衰弱 / 衰弱筛查量表 / 埃德蒙顿衰弱评估量表 / 死亡风险 / 照护需求 / 快速筛查 / 结局预测

Key words

inpatients / frailty / FRAIL scale / Edmonton frail scale / mortality risk / care needs / rapid screening / outcome prediction

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基金资助

广西自然科学基金资助项目(2025GXNSFAA069514)