Frailty as a Predictor of Mortality in Late-Life Depression: A Prospective Clinical Cohort Study
Frailty as a Predictor of Mortality in Late-Life Depression: A Prospective Clinical Cohort Study
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衰弱是老年抑郁症死亡率的预测因素：一项前瞻性临床队列研究
DOI：
10.4088/jcp.20m13277
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发表时间：
2021-05-01
影响因子：
5.3
通讯作者：
Voshaar, Richard C. Oude
中科院分区：
文献类型：
--
作者：
Arts, Matheus H. L.;van den Berg, Karen S.;Voshaar, Richard C. Oude
目标：虚弱是一种临床表型，预测负面的健康结果，包括死亡率，并越来越多地用于老年医学的风险分层。与虚弱相似，晚年抑郁症也与死亡率增加有关。因此，我们研究是否脆弱和脆弱相关的生物标志物预测老年抑郁症patients.Methods死亡率：在我们的研究378例老年患者年龄≥ 60岁的抑郁症（DSM-IV标准），我们研究是否脆弱预测时间死亡在6年的随访期间使用考克斯比例风险回归分析调整混杂因素。基线数据是从2007年至2010年9月收集的。根据Fried Frailty Phenotype标准（肌肉无力、缓慢、疲惫、低活动水平、意外体重减轻）定义虚弱。同样，我们研究了3个炎症标志物，维生素D水平和白细胞端粒长度的预测值，以及这些影响是否独立于frailty phenotype.Results：在随访期间，27（26.2%）的103例虚弱抑郁症患者死亡相比，35（12.7%）的275名非虚弱抑郁症患者（P <0.001）。调整混杂因素后，虚弱成分的数量与死亡率增加相关（风险比= 1.38 [95%CI，1.06-1.78]，P = 0.015）。除了白细胞介素6的所有生物标志物均与死亡率前瞻性相关，但只有较高水平的高敏C反应蛋白和较低水平的维生素D是独立的脆弱与mortality.Conclusions：在晚年抑郁症，脆弱确定老年患者的不良健康后果的风险增加。因此，在虚弱的抑郁症患者中，包括针对虚弱的干预措施的治疗模式可能会降低死亡率。
Objective: Frailty is a clinical phenotype that predicts negative health outcomes, including mortality, and is increasingly used for risk stratification in geriatric medicine. Similar to frailty, late-life depression is also associated with increased mortality rates. Therefore, we examined whether frailty and frailty-related biomarkers predict mortality among depressed older patients.Methods: In our study of 378 older patients aged >= 60 years with a depressive disorder (DSM-IV criteria), we examined whether frailty predicts time-to-death during a 6-year follow-up using Cox proportional hazard regression analyses adjusted for confounders. Baseline data were collected from 2007 to September 2010. Frailty was defined according to the Fried Frailty Phenotype criteria (muscle weakness, slowness, exhaustion, low activity level, unintended weight loss). Similarly, we examined the predictive value of 3 inflammatory markers, vitamin D level, and leukocyte telomere length and whether these effects were independent of the frailty phenotype.Results: During follow-up, 27 (26.2%) of 103 frail depressed patients died compared with 35 (12.7%) of 275 non-frail depressed patients (P < .001). Adjusted for confounders, the number of frailty components was associated with an increased mortality rate (hazard ratio = 1.38 [95% CI, 1.06-1.78], P = .015). All biomarkers except for interleukin 6 were prospectively associated with mortality, but only higher levels of high-sensitivity C-reactive protein and lower levels of vitamin D were independent of frailty associated with mortality.Conclusions: In late-life depression, frailty identifies older patients at increased risk of adverse negative health outcomes. Therefore, among frail depressed patients, treatment models that include frailty-specific interventions might reduce mortality rates.