Effectiveness Comparison of Different Frailty Assessment Tools in Preoperative Frailty Screening in the Elderly

doi:10.12114/j.issn.1007-9572.2023.0747

Chinese General Practice ›› 2024, Vol. 27 ›› Issue (30): 3790-3796.DOI: 10.12114/j.issn.1007-9572.2023.0747

• Original Research • Previous Articles Next Articles

Effectiveness Comparison of Different Frailty Assessment Tools in Preoperative Frailty Screening in the Elderly

1. State Key Laboratory of Traditional Chinese Medicine Syndrome, the Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou 510006, China
2. Department of Neurology, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine/Guangdong Hospital of Traditional Chinese Medicine, Guangzhou 510120, China
3. College of Nursing, Hunan University of Traditional Chinese Medicine, Changsha 410208, China
4. Department of Nursing, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine/Guangdong Hospital of Traditional Chinese Medicine, Guangzhou 510120, China
5. State Key Laboratory of Traditional Chinese Medicine Syndrome, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, China

Received:2023-11-10 Revised:2023-12-12 Published:2024-10-20 Online:2024-07-09
Contact: WEI Lin

不同衰弱评估工具在老年术前衰弱筛查中的应用效果比较研究

1．510006　广东省广州市，广州中医药大学第二临床医学院中医证候全国重点实验室
2．510120　广东省广州市，广州中医药大学第二附属医院　广东省中医院神经一科
3．410208　湖南省长沙市，湖南中医药大学护理学院
4．510120　广东省广州市，广州中医药大学第二附属医院　广东省中医院护理部
5．510120　广东省广州市，广州中医药大学第二附属医院中医证候全国重点实验室

通讯作者: 魏琳
作者简介:
作者贡献：
梁好进行研究方案的构思与设计，研究的实施与可行性分析，论文修订；周春姣、傅秀珍、魏琳进行研究的实施与可行性分析；陈木欣、赵怡迪进行数据收集；杨晓敏、方嘉敏进行数据整理；陈木欣进行统计学处理、结果的分析与解释，负责论文撰写及修改；魏琳负责文章的质量控制及审校，对文章整体负责，监督管理。
基金资助:
国家卫生健康委科学技术研究所项目(No.2021KYSHX016010201)

Abstract

Abstract:

Background

There are various frailty assessment tools in the world, and the application choice of frailty assessment tools for the geriatric perioperative population varies. It remains unclear which frailty assessment tool is more suitable for the perioperative population in China.

Objective

To compare the application effects of FRAIL scale, Clinical Frailty Scale (CFS), perioperative frailty index and 5-item modified frailty index (mFI-5) in preoperative frailty assessment in elderly surgical patients, in order to provide a reference for healthcare professionals to choose appropriate frailty assessment tools.

Methods

By convenient sampling method, a total of 329 hospitalized elderly patients admitted to Guangdong Hospital of Traditional Chinese Medicine for elective surgery from February to May 2023 were selected. The mFI-11, FRAIL scale, CFS, mFI-5 and perioperative frailty index were used for frailty assessment. The Kappa test was used to evaluate the consistency between the five frailty assessment tools. Using the mFI-11 evaluation results as a reference, the diagnostic value of the other four tools on the incidence of preoperative frailty in elderly patients was analyzed by decision curve analysis (DCA) and receiver operating characteristic (ROC) curve, and the area under ROC curve (AUC) was calculated. The optimal cut-off values of the four frailty assessment tools were determined according to the Yoden index. The performance indicators of the four frailty assessment tools at the original and optimal cut-off values were calculated.

Results

CFS and perioperative frailty index showed the highest consistency in the assessment of preoperative frailty in the elderly (Kappa=0.655, P<0.001), FRAIL had the lowest consistency with mFI-5 and mFI-11 in the evaluation of preoperative frailty in the elderly (Kappa=0.182, 0.262). ROC results showed that the AUC of mFI-5, perioperative frailty index, CFS and FRAIL for preoperative frailty screening in the elderly were 0.920, 0.888, 0.823 and 0.799, respectively. The AUC of mFI-5 in screening preoperative frailty in the elderly was greater than that of FRAIL scale and CFS (Z=3.188, 3.215; P=0.001). The AUC of perioperative frailty index was greater than that of FRAIL scale (Z=2.561, P=0.001). The sensitivity (91.18%) and specificity (84.41%) of mFI-5, the sensitivity (94.12%) and specificity (71.86%) of perioperative frailty index were higher in the optimal cut-off value. The DCA results showed that the net benefit of mFI-5 was the highest, followed by perioperative frailty index within the relevant risk thresholds.

Conclusion

The screening accuracy of mFI-5 is the highest, with high sensitivity and specificity at the optimal critical value. The perioperative frailty index has the second highest screening accuracy but relatively good overall predictive performance. Both of them are suitable for early frailty risk screening in elderly surgical patients.

Key words: Frailty, Preoperative frailty, Screening, Assessment tools, Aged, Evaluation research

摘要：

背景

国际上衰弱评估工具种类繁多，针对老年围术期的衰弱评估工具的应用选择不一，哪种衰弱评估工具更适合我国围术期人群尚不清楚。

目的

比较FRAIL量表、临床衰弱量表（CFS）、围术期衰弱指数、5项改良衰弱指数（mFI-5）在老年手术患者中术前衰弱评估的应用效果，旨在为医护人员选择合适的衰弱评估工具提供参考。

方法

采用方便抽样法选取2023年2—5月于广东省中医院行择期手术的住院老年患者329例作为研究对象。采用11项改良衰弱指数（mFI-11）、FRAIL量表、CFS、mFI-5、围术期衰弱指数进行衰弱评估。应用Kappa检验评估5种衰弱评估工具之间的一致性；以mFI-11评估结果为参考，通过受试者工作特征（ROC）曲线和决策曲线（DCA）分析其余4种工具对老年术前衰弱发生率的诊断价值，计算ROC曲线下面积（AUC）；根据约登指数（YI）最大原则确定各衰弱评估工具的最佳临界值，并分别计算在原始和最佳临界值时的评估性能指标。

结果

CFS与围术期衰弱指数对老年术前衰弱的评估一致性最高（Kappa=0.655，P<0.001），FRAIL量表与mFI-5及mFI-11对老年术前衰弱的评估一致性最低（Kappa=0.182、0.262）。ROC曲线分析结果显示，mFI-5、围术期衰弱指数、CFS及FRAIL量表筛查老年术前衰弱的AUC分别为0.920、0.888、0.823及0.799；mFI-5筛查老年术前衰弱的AUC大于FRAIL量表、CFS（Z=3.188、3.215，P=0.001）；围术期衰弱指数筛查老年术前衰弱的AUC大于FRAIL量表（Z=2.561，P=0.001）；在最佳临界值时，mFI-5筛查老年术前衰弱的灵敏度（91.18%）及特异度（84.41%）、围术期衰弱指数筛查老年术前衰弱的灵敏度（94.12%）及特异度（71.86%）等指标较高。DCA结果显示，在相关风险阈值范围内，mFI-5的净效益最高、围术期衰弱指数次之。

结论

mFI-5的筛查准确性最高，且在最佳临界值时具有较高的灵敏度和特异度，围术期衰弱指数的筛查准确性次之但综合预测性能相对较好，两者适用于老年手术患者的早期衰弱风险筛查。

关键词: 衰弱, 术前衰弱, 筛查, 评估工具, 老年人, 评价研究

CLC Number:

R 364

CHEN Muxin,LIANG Hao,ZHAO Yidi, et al. Effectiveness Comparison of Different Frailty Assessment Tools in Preoperative Frailty Screening in the Elderly[J]. Chinese General Practice, 2024, 27(30): 3790-3796. DOI: 10.12114/j.issn.1007-9572.2023.0747.
陈木欣,梁好,赵怡迪等. 不同衰弱评估工具在老年术前衰弱筛查中的应用效果比较研究[J]. 中国全科医学, 2024, 27(30): 3790-3796. DOI: 10.12114/j.issn.1007-9572.2023.0747.

Figures/Tables 6

References 36

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项目	数值
年龄[M（P₂₅，P₇₅），岁]	69（65，73）
性别[例（%）]
男	133（40.4）
女	196（59.6）
婚姻状况[例（%）]
未婚	0
已婚	302（91.8）
离异	3（0.9）
丧偶	24（7.3）
文化程度[例（%）]
小学及以下	155（47.1）
初中	83（25.2）
高中或中专	66（20.1）
大专及以上	25（7.6）
吸烟[例（%）]
是	45（13.7）
否	246（74.8）
已戒烟	38（11.5）
饮酒[例（%）]
是	21（6.4）
否	277（84.2）
已戒酒	31（9.4）
多重用药≥5种[例（%）]
是	26（7.9）
否	303（92.1）
FRAIL量表≥3分[例（%）]	46（14.0）
CFS量表≥5级[例（%）]	69（21.0）
mFI-11≥3分[例（%）]	34（10.3）
围术期衰弱指数≥8分[例（%）]	51（15.5）
mFI-5≥3分[例（%）]	77（23.4）

项目	数值
年龄[M（P₂₅，P₇₅），岁]	69（65，73）
性别[例（%）]
男	133（40.4）
女	196（59.6）
婚姻状况[例（%）]
未婚	0
已婚	302（91.8）
离异	3（0.9）
丧偶	24（7.3）
文化程度[例（%）]
小学及以下	155（47.1）
初中	83（25.2）
高中或中专	66（20.1）
大专及以上	25（7.6）
吸烟[例（%）]
是	45（13.7）
否	246（74.8）
已戒烟	38（11.5）
饮酒[例（%）]
是	21（6.4）
否	277（84.2）
已戒酒	31（9.4）
多重用药≥5种[例（%）]
是	26（7.9）
否	303（92.1）
FRAIL量表≥3分[例（%）]	46（14.0）
CFS量表≥5级[例（%）]	69（21.0）
mFI-11≥3分[例（%）]	34（10.3）
围术期衰弱指数≥8分[例（%）]	51（15.5）
mFI-5≥3分[例（%）]	77（23.4）

评估工具	Kappa值	P值
FRAIL量表^*CFS	0.446	<0.001
FRAIL量表^*mFI-11	0.262	<0.001
FRAIL量表^*围术期衰弱指数	0.432	<0.001
FRAIL量表^*mFI-5	0.182	0.001
CFS^*mFI-11	0.358	<0.001
CFS^*围术期衰弱指数	0.655	<0.001
CFS^*mFI-5	0.420	<0.001
mFI-11^*围术期衰弱指数	0.449	<0.001
mFI-11^*mFI-5	0.485	<0.001
mFI-5^*围术期衰弱指数	0.385	<0.001

评估工具	Kappa值	P值
FRAIL量表^*CFS	0.446	<0.001
FRAIL量表^*mFI-11	0.262	<0.001
FRAIL量表^*围术期衰弱指数	0.432	<0.001
FRAIL量表^*mFI-5	0.182	0.001
CFS^*mFI-11	0.358	<0.001
CFS^*围术期衰弱指数	0.655	<0.001
CFS^*mFI-5	0.420	<0.001
mFI-11^*围术期衰弱指数	0.449	<0.001
mFI-11^*mFI-5	0.485	<0.001
mFI-5^*围术期衰弱指数	0.385	<0.001

评估工具	临界值	特异度（%）	灵敏度（%）	YI	NPV（%）	PPV（%）	AUC
FRAIL量表	≥3分	89.15	41.18	0.304 0	90.32	38.15	0.799
	>1分^a	59.66	91.18	0.508 4	97.65	26.87
CFS	≥5级^b	84.41	67.65	0.520 5	90.77	53.52	0.823
围术期衰弱指数	≥8分	91.19	58.82	0.500 0	92.35	55.05	0.888
	>4.5分^a	71.86	94.12	0.659 8	98.52	38.02
mFI-5	≥2分^b	84.41	91.18	0.755 8	96.91	64.11	0.920

Effectiveness Comparison of Different Frailty Assessment Tools in Preoperative Frailty Screening in the Elderly

不同衰弱评估工具在老年术前衰弱筛查中的应用效果比较研究

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评估工具	Z值	P值
FRAIL量表^*CFS	0.780	0.435
FRAIL量表^*围术期衰弱指数	2.561	0.010
FRAIL量表^*mFI-5	3.188	0.001
CFS^*围术期衰弱指数	1.957	0.050
CFS^*mFI-5	3.215	0.001
围术期衰弱指数^*mFI-5	1.059	0.289

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