低体重指数对老年共病患者预后价值的研究

Prognostic Value of Low Body Mass Index in Elderly Patients with Comorbidities

摘要: 研究目的：探讨低体重指数(body mass index, BMI)与老年共病患者发生不良预后结局的关系。研究方法：纳入2018年7月至2019年6月就诊于青岛大学附属医院保健科的60岁以上的老年住院患者350例。研究对象依据BMI < 18.50 kg/m2与18.50 ≤ BMI < 24.00 kg/m2分为2组。同时收集所有研究对象的一般资料及相关的实验室检查结果，并进行相关的医学评分，每位研究对象在出院后进行为期1年的随访，记录其发生终点事件的时间。生存时间即发生终点事件日期与先前所记录BMI日期的时间差。组间比较采用Pearson卡方(χ2)检验或fisher精确检验，采用Kaplan-Meier法进行单因素生存分析，其后采用Cox回归模型多因素分析影响患者的生存率的危险因素，自变量为已用单因素分析评估过的有意义的因素。以P < 0.05为差异有统计学意义。研究结果：两组患者PA、Alb、共病指数、共病指数、NRS2002、ADL评分、衰弱量表、是否发生终点事件间差异具有统计学意义(P < 0.05)。BMI、共病指数、NRS2002、ADL评分指标均是影响患者发生不良结局的独立危险因素(P < 0.05)，且BMI越小，NRS2002越高，ADL评分越小，共病指数越高，患者发生不良结局的风险越高，而其余指标均不是影响患者发生不良结局的独立危险因素(P > 0.05)。研究结果：在BMI < 24 kg/m2的老年共病患者中，低BMI、高共病指数、高NRS2002、低ADL评分均是影响患者发生MACE、AECOPD、脑卒中及TIA、严重感染及其他可引起老年人急诊入院或死亡等不良结局的独立危险因素。

Abstract: Objective: To investigate the relationship between low body mass index (BMI) and poor prognosis in elderly patients with comorbidities. Methods: A total of 350 elderly inpatients over 60 years old who were admitted to the Health Care Department of the Affiliated Hospital of Qingdao University from July 2018 to June 2019 were included. Subjects were divided into two groups according to BMI < 18.50 kg/m2 or 18.50 ≤ BMI < 24.00 kg/m2. At the same time, the general data and relevant laboratory examination results of all subjects were collected, and the relevant medical scores were made. Each subject was followed up for 1 year after discharge, and the time of occurrence of the end event was recorded. Survival time is the time difference between the date of the end event and the previously recorded BMI date. Comparison between groups was performed by Pearson chi-square (χ2) test or Fisher's exact test. Univariate survival analysis was performed by Kaplan-Meier method, followed by multivariate analysis of risk factors affecting survival by Cox regression model. The independent variables were significant factors that had been evaluated by univariate analysis. P < 0.05 was considered statistically significant. Results: There were statistically significant differences in PA, ALB, comorbidity index, comorbidity index, NRS2002, ADL score, frailty scale and endpoint event between 2 groups (P < 0.05). BMI, comorbidity index, NRS2002, and ADL score were all independent risk factors for adverse outcomes in patients (P < 0.05), and the smaller the BMI, the higher the NRS2002, the smaller the ADL score, the higher the comorbidity index, and the higher the risk of adverse outcomes in patients. The other indicators were not independent risk factors for adverse outcomes (P > 0.05). Conclusion: In the elderly comorbidities with BMI < 24 kg/m2, low BMI, high comorbidities, high NRS2002, and low ADL score were all independent risk factors for MACE, AECOPD, stroke, TIA, severe infection, and other adverse outcomes that could lead to emergency admission or death in the elderly.