Đánh giá tính đồng thuận và giá trị chẩn đoán của thang đo suy yếu lâm sàng giản lược trên bệnh nhân cao tuổi được can thiệp mạch vành qua da tiên phát=Assessment of agreement and diagnostic value of the simplified clinical frailty scale in elderly patients undergoing primary percutaneous coronary intervention

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Tác giả: Lê Hoàng Phụng Nguyễn, Phan Hoàng Phúc Nguyễn, Thế Quyền Nguyễn, Văn Tân Nguyễn, Văn Trí Nguyễn

Ngôn ngữ: vie

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Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.308-317

Bộ sưu tập: Metadata

ID: 243578

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Thẩm định tính đồng thuận và giá trị chẩn đoán suy yếu của thang đo suy yếu lâm sàng giản lược so với phiên bản đầy đủ trong chẩn đoán suy yếu ở bệnh nhân (BN) cao tuổi nhồi máu cơ tim cấp có ST chênh lên (NMCT có STCL) được can thiệp mạch vành qua da (CTMVQD) tiên phát. Phương pháp: Nghiên cứu cắt ngang trên 1460 BN cao tuổi được thực hiện CTMVQD tiên phát. Suy yếu theo s-CFS và CFS phiên bản đầy đủ được đánh giá tại thời điểm 2 tuần trước khi xảy ra biến cố NMCT có STCL. Mối tương quan giữa 2 thang đo được đánh giá bằng hệ số tương quan Pearson r. Tính đồng thuận giữa 2 thang đo được đánh giá bằng hệ số Cohen’s Kappa và hệ số tương quan nội bộ nhóm. Giá trị chẩn đoán suy yếu của s-CFS so với tiêu chuẩn vàng là CFS phiên bản đầy đủ được đánh giá thông qua diện tích dưới đường cong (AUC) và các thông số về giá trị chẩn đoán. Kết quả: Nghiên cứu nhận vào 1.460 BN thỏa tiêu chuẩn. Về giá trị chẩn đoán, so với tiêu chuẩn vàng chẩn đoán suy yếu là CFS ≥ 5, s-CFS tại điểm cắt bằng 5 là tối ưu nhất với độ nhạy 99,7%, độ đặc hiệu 100% và AUC = 0,999. Về tính đồng thuận giữa 2 thang đo, hệ số tương quan Pearson r = 0,78, hệ số tương quan nội bộ nhóm tại từng điểm số = 0,758 và hệ số Cohen’s Kappa tại ngưỡng chẩn đoán suy yếu (s- CFS và CFS ≥ 5) = 0,998 (p <
0,001). Kết luận: Trên BN cao tuổi sau CTMVQD tiên phát, thang đo suy yếu lâm sàng giản lược có giá trị chẩn đoán suy yếu tương đương với thang đo suy yếu lâm sàng phiên bản đầy đủ. Các thông số thống kê về tính đồng thuận đạt mức rất tốt trong đánh giá các mức độ của suy yếu giữa 2 thang đo.The simplified Clinical Frailty Scale (s-CFS) has been recently developed to simplify the full version of the Clinical Frailty Scale (CFS) and make it more accessible in clinical practice. However, this scale has not yet been validated for reliability and diagnostic value of frailty across different populations. Objective: To validate the reliability and diagnostic value of frailty of the simplified Clinical Frailty Scale compared to the full version in diagnosing frailty in elderly patients with acute myocardial infarction with ST-segment elevation (STEMI) who underwent primary percutaneous coronary intervention (PCI). Methods: A cross-sectional study on 1460 elderly patients undergoing primary PCI. Frailty state according to s-CFS and the full version of CFS were assessed at 2 weeks before the incidence of STEMI. The correlation between the two scales was evaluated by Pearson's correlation coefficient r. The agreement between the two scales was assessed by Cohen’s Kappa coefficient and the intra-group correlation coefficient. The diagnostic value of frailty of s- CFS compared to the gold standard, the full version of CFS, was evaluated through the area under the curve (AUC) and parameters regarding diagnostic value. Results: 1.460 patients eligible for the criteria were recruited. Regarding diagnostic value, compared to the gold standard of frailty diagnosis (CFS ≥ 5), the s-CFS at a cutoff of 5 was optimal with 99.7% sensitivity, 100% specificity, and an AUC of 0.999. Regarding agreement between the two scales, the Pearson correlation coefficient r was 0.78, the intragroup correlation coefficient at each score was 0.758, and the Cohen’s Kappa coefficient at the frailty diagnosis threshold (s-CFS and CFS ≥ 5) was 0.998 (p <
0.001). Conclusion: In elderly patients undergoing primary percutaneous coronary intervention, the simplified clinical frailty scale has diagnostic value equivalent to the the original clinical frailty scale. The agreement statistics reached an excellent level in assessing the levels of frailty between the two scales.

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