危重症幸存者中虚弱与健康相关生活质量之间的长期关联：一项前瞻性多中心队列研究。

Long-term association between frailty and health-related quality of life among survivors of critical illness: a prospective multicenter cohort study.

机构信息

1Division of Critical Care Medicine (University of Alberta Hospital), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. 2Department of Critical Care Medicine, Faculty of Medicine, University of Calgary, Calgary, Canada. 3School of Public Health, University of Alberta, Edmonton, Canada. 4Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. 5Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. 6EPICORE Centre, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.

出版信息

Crit Care Med. 2015 May;43(5):973-82. doi: 10.1097/CCM.0000000000000860.

DOI:10.1097/CCM.0000000000000860

PMID:25668751

Abstract

OBJECTIVE

Frailty is a multidimensional syndrome characterized by loss of physiologic reserve that gives rise to vulnerability to poor outcomes. We aimed to examine the association between frailty and long-term health-related quality of life among survivors of critical illness.

DESIGN

Prospective multicenter observational cohort study.

SETTING

ICUs in six hospitals from across Alberta, Canada.

PATIENTS

Four hundred twenty-one critically ill patients who were 50 years or older.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Frailty was operationalized by a score of more than 4 on the Clinical Frailty Scale. Health-related quality of life was measured by the EuroQol Health Questionnaire and Short-Form 12 Physical and Mental Component Scores at 6 and 12 months. Multiple logistic and linear regression with generalized estimating equations was used to explore the association between frailty and health-related quality of life. In total, frailty was diagnosed in 33% (95% CI, 28-38). Frail patients were older, had more comorbidities, and higher illness severity. EuroQol-visual analogue scale scores were lower for frail compared with not frail patients at 6 months (52.2 ± 22.5 vs 64.6 ± 19.4; p < 0.001) and 12 months (54.4 ± 23.1 vs 68.0 ± 17.8; p < 0.001). Frail patients reported greater problems with mobility (71% vs 45%; odds ratio, 3.1 [1.6-6.1]; p = 0.001), self-care (49% vs 15%; odds ratio, 5.8 [2.9-11.7]; p < 0.001), usual activities (80% vs 52%; odds ratio, 3.9 [1.8-8.2]; p < 0.001), pain/discomfort (68% vs 47%; odds ratio, 2.0 [1.1-3.8]; p = 0.03), and anxiety/depression (51% vs 27%; odds ratio, 2.8 [1.5-5.3]; p = 0.001) compared with not frail patients. Frail patients described lower health-related quality of life on both physical component score (34.7 ± 7.8 vs 37.8 ± 6.7; p = 0.012) and mental component score (33.8 ± 7.0 vs 38.6 ± 7.7; p < 0.001) at 12 months.

CONCLUSIONS

Frail survivors of critical illness experienced greater impairment in health-related quality of life, functional dependence, and disability compared with those not frail. The systematic assessment of frailty may assist in better informing patients and families on the complexities of survivorship and recovery.

摘要

目的

衰弱是一种多维综合征，其特征是生理储备减少，导致对不良结局的脆弱性。我们旨在研究衰弱与危重病幸存者长期健康相关生活质量之间的关系。

设计

前瞻性多中心观察队列研究。

地点

加拿大阿尔伯塔省六家医院的 ICU。

患者

421 名年龄在 50 岁或以上的危重病患者。

干预措施

无。

测量和主要结果

临床虚弱量表评分>4 分表示衰弱。健康相关生活质量通过 EuroQol 健康问卷和短期 12 项身体和心理成分评分在 6 个月和 12 个月时进行测量。使用广义估计方程的多变量逻辑和线性回归来探讨衰弱与健康相关生活质量之间的关系。共有 33%（95%CI，28-38）诊断为衰弱。虚弱患者年龄较大，合并症更多，疾病严重程度更高。与非虚弱患者相比，虚弱患者在 6 个月（52.2±22.5 与 64.6±19.4；p<0.001）和 12 个月（54.4±23.1 与 68.0±17.8；p<0.001）时 EuroQol-视觉模拟量表评分较低。虚弱患者在移动（71%比 45%；优势比，3.1[1.6-6.1]；p=0.001）、自我护理（49%比 15%；优势比，5.8[2.9-11.7]；p<0.001）、日常活动（80%比 52%；优势比，3.9[1.8-8.2]；p<0.001）、疼痛/不适（68%比 47%；优势比，2.0[1.1-3.8]；p=0.03）和焦虑/抑郁（51%比 27%；优势比，2.8[1.5-5.3]；p=0.001）方面的问题更大。与非虚弱患者相比，虚弱患者在 12 个月时的健康相关生活质量在身体成分评分（34.7±7.8 与 37.8±6.7；p=0.012）和心理成分评分（33.8±7.0 与 38.6±7.7；p<0.001）方面均较低。