老年缺血性脑卒中病人衰弱影响因素分析及风险预测模型构建

    Analysis of the influencing factors of frailty in elderly patients with ischemic stroke and construction of risk prediction model

    • 摘要:
      目的  探讨老年缺血性脑卒中病人衰弱影响因素,构建衰弱的风险预测模型,为早期识别和预防衰弱发生提供参考依据。
      方法  采用便利抽样方法选取231例老年缺血性脑卒中病人为研究对象,依据是否发生衰弱分为衰弱组及非衰弱组。采用二分类logistic回归分析衰弱的独立影响因素,通过Hosmer-Lemeshow检验及受试者工作特征曲线(ROC)分别检验模型拟合优度及预测效果。
      结果  231例病人衰弱发生率为47.18%(109/231)。年龄(OR=1.095,P < 0.01)、体育锻炼(OR=1.944,P < 0.01)、营养风险(OR=2.709,P < 0.01)、ADL障碍(OR=2.095,P < 0.05)、神经功能受损程度高(OR=2.112,P < 0.05)及B-APQ得分高(OR=1.047,P < 0.05)是衰弱发生的独立影响因素。回归模型拟合优度良好(P>0.05),ROC曲线下AUC为0.780(P < 0.01,95%CI:0.721~0.839),约登指数为0.487,最佳临界值为0.416,灵敏度为80.7%,特异度为68.0%,实际应用正确率为74.0%。
      结论  老年缺血性脑卒中病人衰弱发生率偏高,临床要重视高龄、活动度少、营养风险高、需要依赖、神经功能弱及自我感知老化的病人。研究构建的老年缺血性脑卒中病人衰弱风险模型预测良好,能为衰弱风险评估及实施干预方案提供临床参考依据。

       

      Abstract:
      Objective  To explore the influencing factors of frailty in elderly patients with ischemic stroke, and construct a risk prediction model for frailty, so as to provide a reference for early identification and prevention of frailty.
      Methods  A total of 231 elderly patients with ischemic stroke were selected by convenience sampling method, and divided into the frailty group and non-frailty group according to whether the frailty occurred.Binary logistic regression was used to analyze the independent influencing factors of frailty.The Hosmer-Lemeshow test and receiver operating characteristic (ROC) curve were used to test the goodness of fit and prediction effect of model, respectively.
      Results  The incidence rate of frailty in 231 patients was 47.18%(109/231).Thr age(OR=1.095, P < 0.01), physical exercise(OR=1.944, P < 0.01), nutritional risk(OR=2.709, P < 0.01), ADL impairment (OR=2.095, P < 0.05), neurological function(OR=2.112, P < 0.05) and B-APQ score(OR=1.047, P < 0.05) were the independent factors of occurrence of frailty.The regression model had good goodness of fit(P>0.05), and the AUC under ROC curve was 0.780(P < 0.01, 95%CI: 0.721-0.839), the Yoden index was 0.487, the optimal critical value was 0.416, the sensitivity was 80.7%, the specificity was 68.0%, and the actual application accuracy was 74.0%.
      Conclusions  Elderly patients with ischemic stroke have a high incidence of frailty.Clinical attention should be paid to the patients with old age, low activity, high nutritional risk, need dependence, weak neurological function and self-perceived aging.The prediction of frailty risk model in elderly patients with ischemic stroke is good, which can provide clinical reference in the risk assessment and implementation of intervention programs for frailty.

       

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