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目的：探究术前实验室衰弱指数(FI-Lab)与心脏手术后患者全因死亡率的相关性。方法：回顾性分析重症监护医学信息数据库Ⅳ(MIMIC-Ⅳ)数据库(3.1版)行心脏手术后的患者，利用患者入院首次获得的33个常规实验室和生命体征参数，构建FI-Lab评分，并将患者按四分位数分组(Q1～Q4)。采用Kaplan-Meier生存分析曲线和Log-rank检验评估组间生存差异。应用多变量Cox风险回归模型和限制性立方样条，分析FI-Lab与28天及1年死亡率的相关性。结果：共纳入5 273例患者，心脏手术后28天和1年死亡率分别为2.69%和8.67%。Kaplan-Meier生存曲线显示，FI-Lab的Q1组到Q4组的死亡风险呈现梯度性升高趋势(均P<0.001)。经多变量校正后，FI-Lab评分每增加0.01个单位，28天及1年死亡风险分别增加4.3%(HR=1.043, 95%CI:1.027,1.059)和4.8%(HR=1.048, 95%CI:1.039,1.058)。与最低四分位组(Q1)相比，最高四分位组(Q4)患者的28天死亡风险增加4.294倍(HR=5.294, 95%CI:2.068,13.549),1年死亡风险增加4.391倍(HR=5.391, 95%CI:3.353,8.667)。结论：术前FI-Lab评分可独立预测心脏手术患者的短期及长期死亡风险。将该指标纳入术前风险评估体系，有助于早期识别高危人群，并为临床医生制定个体化术后管理方案提供依据。
Abstract：Objective: To investigate the association between frailty index based on laboratory tests(FI-Lab) and all-cause mortality among patients undergoing cardiac surgery. Methods: In this retrospective cohort study, we analyzed data from the medical information mart for intensive care Ⅳ(MIMIC-Ⅳ) database(version 3.1). Using 33 conventional laboratory and vital sign parameters obtained by the patients for the first time upon admission, the FI-Lab score was constructed. Patients were stratified into quartiles(Q1-Q4) based on FI-Lab scores. Survival differences were assessed using Kaplan-Meier survival analysis with the Log-rank test. A multivariable Cox regression model and restricted cubic splines were applied to analyze the association of FI-Lab with 28-day and 1-year mortality. Results: Among 5 273 patients, 28-day and 1-year mortality rates were 2.69% and 8.67%, respectively. Kaplan-Meier curves demonstrated dose-dependent mortality risks across the FI-Lab quartiles(both P<0.001). After adjustment for relevant confounding factors, each 0.01-unit increase in the FI-Lab score was associated with 4.3%(HR=1.043, 95%CI: 1.027, 1.059) and 4.8%(HR=1.048, 95%CI: 1.039, 1.058) increase in the risks of 28-day and 1-year mortality, respectively. Patients in the highest quartile(Q4) had 4.294-fold(HR=5.294, 95%CI:2.068,13.549) and 4.391-fold(HR=5.391, 95%CI:3.353,8.667) higher risks of 28-day and 1-year mortality, respectively, compared with Q1. Conclusion: Preoperative FI-Lab scores independently predicted short-and long-term mortality after cardiac surgery. Incorporating this index into preoperative risk assessment may facilitate the early identification of high-risk populations and guide clinicians in personalizing postoperative management.
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基本信息:
DOI：
中图分类号:R654.2
引用信息:
[1]钟宇,易可欣,龚园.实验室衰弱指数与心脏手术后全因死亡率的关系[J].巴楚医学,2025,8(04):29-37.
基金信息:
湖北陈孝平科技发展基金会青年科学家基金(CHXPJH12001-2424); 分子影像湖北省重点实验室开放基金项目(2023fzyx024)