Fried衰弱表型、肝脏衰弱指数和简易体能状况量表对肝硬化患者预后的预测价值比较

Comparative analysis of the predictive value of fried frailty phenotype， liver fraily index and short physical performance battery in the prognosis of patients with liver cirrhosis.

Objective: To investigate the value of Fried Frailty Phenotype （FFP）， liver frailty index （LFI）， and Short Physical Performance Battery （SPPB） in predicting 2-year all-cause mortality and decompensation events in patients with liver cirrhosis. Methods: A total of 277 patients with liver cirrhosis who were hospitalized in Beijing Friendship Hospital， Capital Medical University， from December 2020 to December 2021 were enrolled， and FFP， LFI， and SPPB were used to assess the state of frailty. Based on the scores of each tool， these patients were divided into frail and non-frail groups. These three tools were compared in terms of consistency and independent predictive performance. The primary endpoints were 2-year all-cause mortality rate and composite endpoints （death+decompensation events）， and the Cox regression analysis， the receiver operating characteristic （ROC） curve， net reclassification index （NRI）， and integrated discrimination improvement （IDI） index were used to analyze the predictive value of the three tools. Normally distributed continuous data were compared between two groups using the independent samples t-test， while non-normally distributed continuous data were compared using the Mann-Whitney U test. Categorical data were compared between groups using the chi-square test or Fisher's exact test. The agreement among different frailty tools was evaluated using Cohen's Kappa statistic. The Kaplan-Meier survival curve was plotted， and a survival analysis was performed using the log-rank test. Results: The prevalence rate of frailty assessed by FFP， LFI， and SPPB was 37.2%， 22.4%， and 20.2%， respectively， with a moderate consistency between FFP and LFI/SPPB （κ=0.57， 95% confidence interval ［CI］： 0.47 — 0.67； κ=0.51， 95%CI： 0.41 — 0.62） and a relatively high consistency between LFI and SPPB （κ=0.87， 95%CI： 0.80 — 0.94）. Compared with the non-frailty group， the frailty group had significantly higher all-cause mortality rate and incidence rate of composite endpoints （P0.001）. After multivariate adjustment， FFP， LFI， and SPPB had a hazard ratio of 2.42（95%CI： 1.51 — 5.11）， 2.21（95%CI： 1.11 — 4.42）， and 2.21（95%CI： 1.14 — 4.30）， respectively， in predicting all-cause mortality， as well as a hazard ratio of 2.51（95%CI： 1.61 — 3.91）， 2.40（95%CI： 1.51 — 3.80）， and 2.20（95%CI： 1.39 — 3.47）， respectively， in predicting composite endpoints. Compared with Child-Pugh score， FFP had a significantly greater area under the ROC curve （AUC） in predicting all-cause mortality （0.79 vs 0.69， P=0.032） and composite endpoints （0.75 vs 0.68， P=0.044）. Frailty assessment tools combined with Child-Pugh score significantly improved the performance in predicting all-cause mortality and composite endpoints， with an AUC of 0.81 — 0.82 and 0.77 — 0.78， respectively （P0.05）. NRI and IDI analyses further confirmed the improvement of the combined model in classification （all P0.001）. Conclusion: FFP， LFI， and SPPB can independently predict adverse outcomes in patients with liver cirrhosis， among which FFP has the best predictive performance， and the combination of frailty assessment tools with Child-Pugh score can significantly enhance the accuracy of prognostic evaluation. [ABSTRACT FROM AUTHOR]

目的: 探讨Fried衰弱表型（FFP）、肝脏衰弱指数（LFI）和简易体能状况量表（SPPB）对肝硬化患者2年全因死亡率及失代偿事件的预测价值。 方法: 选取2020年12月—2021年12月首都医科大学附属北京友谊医院收治的277例肝硬化住院患者，采用FFP、LFI和SPPB评估患者衰弱状态，分为衰弱组和非衰弱组，比较3种工具的一致性及其对预后的独立预测效能。主要终点事件为2年全因死亡率和复合终点事件（死亡+失代偿），采用Cox回归、受试者操作特征曲线（ROC曲线）、净重新分类指数（NRI）和综合判别改善指数（IDI）分析3种工具的预测价值。符合正态分布的计量资料两组间比较采用成组t检验；不符合正态分布的计量资料两组间比较采用Mann-Whitney U检验；计数资料组间比较采用χ2检验或Fisher精确检验。不同衰弱工具间一致性比较采用Cohen's Kappa检验。绘制Kaplan-Meier生存曲线，生存分析采用Log-rank检验。 结果: FFP、LFI和SPPB评估的衰弱患病率分别为37.2%、22.4%和20.2%，FFP与LFI、SPPB一致性中等（κ=0.57，95%CI：0.47～0.67；κ=0.51，95%CI：0.41～0.62），而LFI与SPPB一致性较高（κ=0.87，95%CI：0.80～0.94）。衰弱组全因死亡率及复合终点发生率均显著高于非衰弱组（P值均0.001）。多因素校正后，FFP、LFI、SPPB预测全因死亡率的风险比（HR）分别为2.42（95%CI：1.51～5.11）、2.21（95%CI：1.11～4.42）和2.21（95%CI：1.14～4.30），预测复合终点的HR分别为2.51（95%CI：1.61～3.91）、2.40（95%CI：1.51～3.80）和2.20（95%CI：1.39～3.47）。FFP对全因死亡率的预测ROC曲线下面积（AUC）（0.79 vs 0.69，P=0.032）及复合终点的预测AUC（0.75 vs 0.68，P=0.044）均显著高于Child-Pugh评分。联合衰弱评估工具与Child-Pugh评分的结合可显著提升预测效能（全因死亡AUC为0.81～0.82，复合终点AUC为0.77～0.78，P值均0.05）。NRI和IDI分析进一步证实了联合模型在分类上的改进（P值均0.001）。 结论: FFP、LFI和SPPB均可独立预测肝硬化患者的不良结局，其中FFP的预测效能最佳，且与Child-Pugh评分联合使用可显著提高预后评估的准确性。 [ABSTRACT FROM AUTHOR]