Guillermo Miguel-Ruano, María Aymerich-De-Franceschi, Miguel Ángel García-Aroca, Edgar Benitez, Nicolás Pérez-Fernández, José Manuel Álvarez-Avello
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引用次数: 0
Abstract
Background: Frailty is a useful prognostic concept which has spread to many clinical settings, including perioperative medicine. However, there is no consensus on its definition. This situation could impair its screening and the correction of underlying disturbances that have an influence on the clinical course of ageing patients.
Methods: In order to achieve a more precise characterisation of frailty, an exploratory factor analysis (EFA) was performed on the variables of eight frailty scales: Clinical Frailty Scale (CFS), FRAIL scale, Edmonton scale, Fried criteria, Robinson scale, Risk Analysis Index, the Frailty Index and the Modified Frailty Index. Later, a concordance study between the factors found in EFA and frailty according to the CFS (≥ 4 points) was conducted. One-hundred nine preoperative patients aged 65 years or older (60% men) were included, and data were collected from medical history and physical and laboratory tests. Our aim was to explain the behaviour of well-known frailty-related variables by identifying the factors that influenced them and to investigate whether these factors were related to frailty.
Results: Three factors were found, each relating to a different set of variables: F1 representing comorbidities; F2 being an aggregation of disturbances in physical activity, cognitive status and anaemia; and F3 portraying alterations of the emotional sphere. The concordance study showed a strong association of F2 with frailty: adjusted OR 3.65 (95% CI 1.57 to 8.53). F3 presented a milder relationship: OR 2.54 (95% CI 1.28 to 5.02). No association of F1 with frailty was found: OR 1.15 (95% CI 0.58 to 2.26).
Conclusions: In our quest to characterise frailty, we found that this is best described by an aggregate of reductions in physical activity, impairment in cognitive status and anaemia, while comorbidities are not associated with it. This could support a modified version of the phenotypic model against other paradigms.
背景：虚弱是一个有用的预后概念，已经传播到许多临床环境，包括围手术期医学。然而，对其定义尚无共识。这种情况可能会损害其筛选和纠正潜在的干扰，对老年患者的临床过程产生影响。方法：为了更准确地表征衰弱，对临床衰弱量表（CFS）、虚弱量表、埃德蒙顿量表、Fried标准、Robinson量表、风险分析指数、衰弱指数和修正衰弱指数等8种衰弱量表的变量进行探索性因素分析（EFA）。随后，根据CFS（≥4分）对EFA中发现的因素与虚弱进行了一致性研究。纳入了109名年龄在65岁或以上的术前患者（60%为男性），并收集了病史、体格和实验室检查的数据。我们的目的是通过确定影响它们的因素来解释众所周知的脆弱相关变量的行为，并调查这些因素是否与脆弱有关。结果：发现了三个因素，每个因素都与一组不同的变量相关：F1代表合并症；F2是身体活动障碍、认知状况和贫血的综合；F3描绘了情感领域的变化。一致性研究显示F2与虚弱有很强的相关性：校正OR为3.65 （95% CI 1.57 ~ 8.53）。F3表现出较温和的相关性：OR为2.54 （95% CI 1.28至5.02）。没有发现F1与虚弱相关：OR 1.15 （95% CI 0.58至2.26）。结论：在我们寻找虚弱特征的过程中，我们发现身体活动减少、认知能力受损和贫血是最好的描述，而合并症与之无关。这可能支持表型模型的修改版本，以对抗其他范式。
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