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目的 探索急诊老年患者衰弱状况及维生素D(VitD)营养状况与衰弱的相关性.方法 横断面研究,收集2021年1-9月于北京博爱医院急诊重症监护病房和急诊留观病房治疗的65岁及以上患者的临床资料;入院后24 h内检测血常规、生化、白细胞介素-6、皮质醇、促甲状腺素、25羟基-维生素D[25(OH)D]水平;进行衰弱筛查问卷(FSQ)、衰弱(FRAIL)、临床衰弱量表(CFS)评分;分别根据3种量表定义患者是否衰弱,报告不同诊断标准的衰弱患病率,采用Spearman检验和Kappa系数对3种量表进行一致性评价.比较衰弱与非衰弱组间临床资料及实验室指标的差异;采用多因素Logistic回归模型分析VitD营养状况与衰弱的相关性.比较不同VitD营养状况组间衰弱患病率的差异,采用受试者工作特征曲线(ROC)评价血清25(OH)D对衰弱的预测能力.结果 共317例患者纳入本研究,依据FSQ、FRAIL、CFS标准,衰弱患病率依次为47.0％、55.2％、69.4％.3种量表依次进行一致性评价,FSQ与FRAIL的Spearman秩相关系数r为0.761(95％CI:0.715～0.806,P＜0.001)、Kappa 系数 0.536(95％CI:0.451～0.621,P＜0.001)均最大.Logistic 回归分析结果显示,调整年龄、性别、体质指数等因素后,VitD缺乏(OR=5.994、95％CI:1.232～29.169、P=0.027)与FSQ衰弱患病率增加呈独立相关.随着VitD营养不良程度加重,衰弱患病率呈递增趋势;VitD缺乏组高于VitD不足及充足组(均P＜0.05).血清25(OH)D水平预测FSQ、FRAIL、CFS衰弱的 ROC 曲线下面积(AUC)依次为 0.806(95％CI:0.744～0.868)、0.748(95％CI:0.679～0.817)、0.768(95％CI:0.701～0.826)(均 P＜0.001),最佳截断值依次为 12.0、9.76、11.65 μg/L,约登指数依次为0.553、0.419、0.462.结论 FSQ、FRAIL、CFS在急诊老年患者衰弱的评估中具有较好的一致性;25(OH)D可作为衰弱的独立预测因子,检测血清25(OH)D水平有助于识别衰弱,可改善急诊老年患者的危险分层.

Objective To examine the prevalence of frailty among elderly patients in the emergency department and to investigate the potential relationship between vitamin D nutritional status and frailty.Methods This study collected clinical data from elderly patients aged over 65 years in the emergency intensive care unit and emergency observation ward of Beijing Bo'Ai Hospital from January to September 2021.The data included blood routine,biochemical indicators,circulating interleukin-6,cortisol,thyrotropin,and 25-hydroxyvitamin D[25(OH)D],which were detected within 24 hours after enrollment.Additionally,the Frailty Screening Questionnaire(FSQ),FRAIL scale,and Clinical Frailty Scale(CFS)were used to score the patients.Based on the scores,the patients were divided into frail or non-frail groups,and the prevalence of frailty was reported accordingly using the criteria of the aforementioned scales.The consistency of the three scales was evaluated using the Spearman rank test and Kappa coefficient.We compared the differences in clinical data and laboratory indicators of patients between the frail and non-frail groups.Additionally,we used a multivariable Logistic regression model to analyze the association between vitamin D nutritional status and frailty.We also analyzed the prevalence of frailty in different vitamin D nutritional statuses and evaluated the predictive ability of serum 25(OH)D for frailty using the receiver operating characteristic(ROC)curve.Results A total of 317 patients were included in the study.The prevalence of frailty in elderly patients in the emergency department was found to be 47.0％,55.2％,and 69.4％according to the FSQ,FRAIL,and CFS scales,respectively.The study evaluated the consistency of these three scales,revealing a Spearman rank correlation coefficient of 0.761(95％CI:0.715-0.806,P＜0.001)and a Kappa coefficient of 0.536(95％CI:0.451-0.621,P＜0.001)between FSQ and FRAIL,which were the highest correlations observed.Logistic regression analysis,after adjusting for age,gender,BMI,and other factors,indicated that vitamin D deficiency(OR=5.994,95％CI:1.232-29.169,P=0.027)was independently associated with an increased prevalence of frailty as defined by FSQ criteria.The prevalence of frailty increased with the severity of vitamin D malnutrition.In the vitamin D deficiency group,the prevalence was higher compared to the vitamin D insufficiency and sufficiency groups(P＜0.05 for all).The area under the ROC curves(AUCs)of serum 25(OH)D levels to predict frailty,as defined by FSQ,FRAIL,and CFS,were 0.806(95％CI:0.744-0.868),0.748(95％CI:0.679-0.817),and 0.768(95％CI:0.701-0.826)(P＜0.001 for all).The optimal cut-off values were 12.0,9.76,and 11.65 μg/L,respectively,yielding a Youden index of 0.553,0.419,and 0.462.Conclusions FSQ,FRAIL,and CFS demonstrated a strong level of consistency in assessing frailty.Additionally,serum 25(OH)D can serve as an independent predictor of frailty,aiding in the identification of frail individuals and enhancing the risk stratification of elderly patients in the emergency department.