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| 改良衰弱指数联合骨骼肌指数对心脏手术患者术后1年内死亡的预测价值 |
| Predictive value of modified frailty index combined with skeletal muscle index for 1-year postoperative mortality after cardiac surgery |
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| DOI：10.12089/jca.2025.11.004 |
| 中文关键词: 衰弱 肌肉减少症 心脏手术 骨骼肌指数 改良衰弱指数 |
| 英文关键词: Frailty Sarcopenia Cardiac surgery Skeletal muscle index Modified frailty index |
| 基金项目:江苏省徐州市科技局基金资助项目（KC20154）；吴阶平医学基金会（HRJJ2018753） |
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| 中文摘要: |
目的：探讨改良衰弱指数联合骨骼肌指数对心脏手术患者术后1年内死亡的预测价值。
方法：回顾性收集2019年1月至2023年1月择期行开胸心脏手术的患者968例，男624例，女344例，年龄≥18岁，BMI 18.5～36.0 kg/m2，ASA Ⅱ—Ⅳ级。根据术后1年内是否死亡将患者分为两组：死亡组和存活组。收集性别、年龄、BMI、ASA分级、吸烟史、饮酒史、术前合并症（高血压、糖尿病、心肌梗死、脑梗死、慢性阻塞性肺疾病等）、实验室检查结果、心肺转流时间、手术时间、ICU时间以及术后住院时间等。根据患者术前1个月内腹部CT扫描结果计算骨骼肌指数。术前麻醉访视时根据电子病历系统评估患者改良衰弱指数。将单因素回归分析中P＜0.2且具有临床意义的因素纳入多因素Logistic回归分析，通过受试者工作特征（ROC）曲线下面积（AUC）评价改良衰弱指数联合骨骼肌指数对术后1年内死亡的预测效能。
结果：术后1年内死亡59例（6.1%）患者。多因素Logistic回归分析显示，衰弱合并肌肉减少症（OR=4.73，95%CI 2.42～9.27，P＜0.001）是心脏手术患者术后1年内死亡的独立危险因素。与传统的风险评估模型比较，改良衰弱指数联合骨骼肌指数评估模型预测效能（AUC=0.763，95%CI 0.735 ～ 0.789）更佳。
结论：衰弱合并肌肉减少症是心脏手术患者术后1年内死亡的独立危险因素，且改良衰弱指数联合骨骼肌指数评估模型的预测效能较好。 |
| 英文摘要: |
Objective: To investigate the predictive value of modified frailty index combined with skeletal muscle index for 1-year postoperative mortality in patients undergoing cardiac surgery.
Methods: A total of 968 patients, 624 males and 344 females, aged ≥ 18 years, BMI 18.5-36.0 kg/m2, ASA physical status Ⅱ-Ⅳ, who underwent elective open heart surgery from January 2019 to January 2023 were retrospectively enrolled. The patients were divided into two groups according to whether death occurred within 1-year postoperatively: the dead group and the survival group. Patients sex, age, BMI, ASA physical status, smoking history, alcohol consumption history,preoperative comorbidities (hypertension, diabetes, myocardial infarction, cerebral infarction, chronic obstructive pulmonary disease, etc.), laboratory test results, cardiopulmonary bypass time, the duration of surgery, length of ICU stay and postoperative stay were collected. The skeletal muscle index was calculated based on the results of abdominal CT scans performed within 1 month preoperatively. The modified frailty index of patients was assessed using the electronic medical record system during preoperative anesthetic visits. Factors with P < 0.2 and clinically significant in the univariate regression analysis were included in the multivariate logistic regression analysis, and the predictive efficacy of the modified frailty index combined with skeletal muscle index on 1-year postoperative mortality was evaluated by area under curve (AUC).
Results: Fifty-nine (6.1%) patients died during the first year after the surgery. Multifactorial logistic regression analysis showed that frailty combined with sarcopenia (OR = 4.73, 95% CI 2.42-9.27, P < 0.001) was the independent risk factor for the 1-year postoperative mortality. Compared with the traditional risk assessment model, the predictive power of the modified frailty index combined with skeletal muscle index (AUC = 0.763, 95% CI 0.735-0.789) was significantly higher.
Conclusion: Frailty combined with sarcopenia was the independent risk factor for the 1-year postoperative mortality, and the predictive power of the modified frailty index combined with skeletal muscle index was significantly better. |
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