比较脆弱性评估方法及其预测晚期慢性病患者不良结果的能力
Hailey V Hildebrand1,2, Oksana Harasemiw1,2, Ranveer Brar1,2
1Chronic Disease Innovation Centre, Seven Oaks General Hospital, University of Manitoba, Winnipeg, Manitoba, Canada.
Clinical journal of the American Society of Nephrology : CJASN
|August 13, 2025
概括
使用行政数据对晚期慢性病 (CKD) 的脆弱性评估显示出确定高风险患者的前景. 大多数行政脆弱性指标预测了慢性脏病患者死亡率和住院等不良结果.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 老年学是一门学科.
- 公共卫生 公共卫生
背景情况:
- 慢性病 (CKD) 患者中,脆弱性很普遍,增加了残疾,住院和死亡的风险.
- 临床脆弱性评估是资源密集的;行政数据为有效识别有风险的个体提供了潜在的替代方案.
- 识别晚期非透析性CKD的脆弱个体对于及时干预至关重要.
研究的目的:
- 为了比较基于行政索赔的脆弱性定义和在患有晚期CKD的成年人中客观测量的脆弱性之间的一致性.
- 检查这些脆弱性定义与死亡率和住院等不良结果的关联.
主要方法:
- 来自曼尼托巴的加拿大脆弱观察和干预试验 (CanFIT) 的高级CKD参与者的队列与行政数据库联系在一起.
- 使用客观指标 (炸脆性表型,SPPB,提供者印象) 和行政数据 (Segal和修改的手术前脆弱性指数) 来评估脆弱性.
- 分析了定义之间的一致性和具有不利结果的关联.
主要成果:
- 该研究包括442名参与者,平均年龄为66岁,58%是男性.
- 根据所使用的定义,脆弱性患病率差异很大 (19% - 70%).
- 脆弱性定义之间的一致性很差 (κ 0.09-0.33). 通过大多数测量方法被确定为脆弱的个体面临着更高的死亡率和住院风险,除了塞格尔脆弱指标.
结论:
- 大多数脆弱性评估模型,包括行政模型,有效地识别了患有高级非透析性CKD的高风险个体.
- 这些发现支持使用行政数据进行脆弱性查,以准干预措施并改善患者的治疗结果.
- 进一步的研究可能会改进行政脆弱性措施,以提高CKD人群的准确性.
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