一项针对年轻危重症患者虚弱状况的前瞻性多中心队列研究。

A prospective multicenter cohort study of frailty in younger critically ill patients.

作者信息

Bagshaw M, Majumdar Sumit R, Rolfson Darryl B, Ibrahim Quazi, McDermid Robert C, Stelfox H Tom

机构信息

Division of Critical Care Medicine (University of Alberta Hospital), Faculty of Medicine and Dentistry, University of Alberta, 2-124 Clinical Sciences Building, 8440-112 Street NW, Edmonton, AB, T6G 2B7, Canada.

Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 5-112 Clinical Sciences Building, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada.

出版信息

Crit Care. 2016 Jun 6;20(1):175. doi: 10.1186/s13054-016-1338-x.

DOI:10.1186/s13054-016-1338-x

PMID:27263535

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4893838/

Abstract

BACKGROUND

Frailty is a multidimensional syndrome characterized by loss of physiologic and cognitive reserve that heightens vulnerability. Frailty has been well described among elderly patients (i.e., 65 years of age or older), but few studies have evaluated frailty in nonelderly patients with critical illness. We aimed to describe the prevalence, correlates, and outcomes associated with frailty among younger critically ill patients.

METHODS

We conducted a prospective cohort study of 197 consecutive critically ill patients aged 50-64.9 years admitted to intensive care units (ICUs) at six hospitals across Alberta, Canada. Frailty was defined as a score ≥5 on the Clinical Frailty Scale before hospitalization. Multivariable analyses were used to evaluate factors independently associated with frailty before ICU admission and the independent association between frailty and outcome.

RESULTS

In the 197 patients in the study, mean (SD) age was 58.5 (4.1) years, 37 % were female, 73 % had three or more comorbid illnesses, and 28 % (n = 55; 95 % CI 22-35) were frail. Factors independently associated with frailty included not being completely independent (adjusted OR [aOR] 4.4, 95 % CI 1.8-11.1), connective tissue disease (aOR 6.0, 95 % CI 2.1-17.0), and hospitalization within the preceding year (aOR 3.3, 95 % CI 1.3-8.1). There were no significant differences between frail and nonfrail patients in reason for admission, Acute Physiology and Chronic Health Evaluation II score, preference for life support, or treatment intensity. Younger frail patients did not have significantly longer (median [interquartile range]) hospital stay (26 [9-68] days vs. 19 [10-43] days; p = 0.4), but they had greater 1-year rehospitalization rates (61 % vs. 40 %; p = 0.02) and higher 1-year mortality (33 % vs. 20 %; adjusted HR 1.8, 95 % CI 1.0-3.3; p = 0.039).

CONCLUSIONS

Prehospital frailty is common among younger critically ill patients, and in this study it was associated with higher rates of mortality at 1 year and with rehospitalization. Our data suggest that frailty should be considered in younger adults admitted to the ICU, not just in the elderly. Additional research is needed to further characterize frailty in younger critically ill patients, along with the ideal instruments for identification.

摘要

背景

衰弱是一种多维度综合征，其特征是生理和认知储备丧失，从而增加了脆弱性。衰弱在老年患者（即65岁及以上）中已有充分描述，但很少有研究评估非老年危重症患者的衰弱情况。我们旨在描述年轻危重症患者中衰弱的患病率、相关因素及预后。

方法

我们对加拿大艾伯塔省六家医院重症监护病房（ICU）收治的197例年龄在50 - 64.9岁的连续危重症患者进行了一项前瞻性队列研究。衰弱定义为入院前临床衰弱量表评分≥5分。采用多变量分析评估ICU入院前与衰弱独立相关的因素以及衰弱与预后的独立关联。

结果

在该研究的197例患者中，平均（标准差）年龄为58.5（4.1）岁，37%为女性，73%患有三种或更多合并症，28%（n = 55；95%CI 22 - 35）为衰弱患者。与衰弱独立相关的因素包括不完全独立（调整后比值比[aOR] 4.4，95%CI 1.8 - 11.1）、结缔组织病（aOR 6.0，95%CI 2.1 - 17.0）以及前一年住院（aOR 3.3，95%CI 1.3 - 8.1）。衰弱和非衰弱患者在入院原因、急性生理与慢性健康状况评估II评分、生命支持偏好或治疗强度方面无显著差异。年轻的衰弱患者住院时间（中位数[四分位间距]）并无显著延长（26[9 - 68]天 vs. 19[10 - 43]天；p = 0.4），但1年再住院率更高（61% vs. 40%；p = 0.02），1年死亡率也更高（33% vs. 20%；调整后风险比1.8，95%CI 1.0 - 3.3；p = 0.039）。