| Objective:To explore the risk factors for cognitive frailty in elderly maintenance hemodialysis patients,and to construct a predictive model for cognitive frailty in elderly maintenance hemodialysis patients,providing evidence for clinical judgment of the risk of cognitive frailty in elderly maintenance hemodialysis patients.Methods:A total of 459 elderly patients from two tertiary hospitals in Huai’an City’s blood purification centers were selected as the modeling group study subjects from January 2022 to October 2022 by convenience sampling method.Information on all patients was collected,including general information questionnaire,Frailty Phenotype(FP),Short From Mini Nutritional Assessment(MNA-SF),Pittsburgh Sleep Quality Indice(PSQI),Mini-Mental State Examination(MMSE),Clinical Dementia Rating(CDR),Geriatric Depression Scale-15(GDS-15),and Social Support Rating Scale(SSRS).Differences between the two groups were compared,and factors with significant differences were included in a binary logistic regression analysis to determine the independent risk factors for cognitive frailty in elderly patients with the disease.A predictive regression equation was constructed and a line chart was plotted based on the logistic regression analysis result parameters.Using the same inclusion criteria,125 elderly patients from a Level 2 Grade A comprehensive hospital in Huai’an City’s blood purification center were selected as the validation group study subjects from November 2022 to February 2023.The data of 125 patients were included in the model formula,and the results were compared with clinical results to calculate the accuracy of the model prediction.The ROC curve was used to analyze the prediction efficacy of the model for cognitive frailty in elderly maintenance hemodialysis patients.Hosmer-Lemeshow goodness-of-fit test was conducted to evaluate the model’s calibration ability.Results:1.Among the 459 patients in the modeling group,146 experienced cognitive frailty,2.with an incidence rate of 31.81%.Among the 125 patients in the validation group,43 experienced cognitive frailty,with an incidence rate of 34.40%.3.Univariate analysis showed that there were statistically significant differences in age,educational level,dialysis age,body mass index,number of complications,history of stroke,cardiovascular history,serum albumin,hemoglobin,Pittsburgh sleep quality index score,Mini-nutritional Assessment Short-Form score,Geriatric Depression Scale-15 score and Social Support Rating Scale score between the cognitive frailty group and the non cognitive frailty group(P<0.05).4.Multivariate analysis showed that age,history of stroke,serum albumin,Mini-nutritional Assessment Short-Form score,and Geriatric Depression Scale-15 score were independent factors associated with cognitive frailty in elderly maintenance hemodialysis patients.5.Building a prediction regression equation based on the parameters of the logistic regression analysis results,and nomogram was drawn.6.The ROC curve analysis of a predictive model for cognitive frailty in elderly maintenance hemodialysis patients showed that the area under the curve was 0.878,the optimal risk cutoff value was 0.653,the sensitivity was 0.886,the specificity was 0.905,and the Jordan index was 0.791.The data of 120 patients were substituted into the model formula,and the prediction accuracy of the model was 89.17%.ROC curve analysis shows that the area under the curve is 0.856.The Hosmer Lemeshow test showed that P=0.549(P>0.05),indicating that the predictive model has a good calibration ability.Conclusion:1.The prevalence of cognitive frailty is relatively high among elderly maintenance hemodialysis patients.2.Elderly maintenance hemodialysis patients with increased age,history of stroke,decreased serum albumin,decreased Mini-nutritional Assessment Short-Form score,and elevated Geriatric Depression Scale-15 scores are prone to cognitive frailty.3.The cognitive frailty prediction model for elderly maintenance hemodialysis patients established in this study has good predictive efficacy and calibration,and can provide a reference for clinical identification of cognitive frailty risks in elderly maintenance hemodialysis patients. |
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