既往健康状况（年龄、合并症和虚弱）如何决定危重症及预后？
How does prior health status (age, comorbidities and frailty) determine critical illness and outcome?
作者信息
Haas Barbara, Wunsch Hannah
机构信息
aDepartment of Surgery and Interdepartmental Division of Critical Care, University of Toronto bDepartment of Critical Care Medicine, Sunnybrook Health Sciences Centre cDepartment of Anesthesia and Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada.
出版信息
Curr Opin Crit Care. 2016 Oct;22(5):500-5. doi: 10.1097/MCC.0000000000000342.
PURPOSE OF REVIEW
Critical illness has a significant impact on an individual's physical and mental health. However, it is less clear to what degree outcomes after critical illness are due to patients' preexisting characteristics, rather than the critical illness itself. In this review, we summarize recent findings regarding the role of age, comorbidity and frailty on long-term outcomes after critical illness.
RECENT FINDINGS
Age, comorbidity and frailty are all associated with an increased risk of critical illness. Although severity of illness drives the risk of acute mortality, recent data suggest that longer term outcomes are much more closely aligned with prior health status. There are growing data regarding the important role of noncardiovascular comorbidity, including psychiatric illness and obesity, in determining long-term outcomes. Finally, preadmission frailty is associated with poor long-term outcomes after critical illness; further data are needed to evaluate the attributable impact of critical illness on the health trajectories of frail individuals.
SUMMARY
Age, comorbidity and frailty play a critical role in determining the long-term outcomes of patients requiring intensive care.
综述目的
危重病对个体的身心健康有重大影响。然而，危重病后的结局在多大程度上归因于患者的既往特征而非危重病本身尚不清楚。在本综述中，我们总结了关于年龄、合并症和衰弱对危重病后长期结局作用的最新研究结果。
最新研究结果
年龄、合并症和衰弱均与危重病风险增加相关。虽然疾病严重程度决定急性死亡风险，但近期数据表明，长期结局与先前健康状况的关联更为密切。关于非心血管合并症（包括精神疾病和肥胖）在决定长期结局中的重要作用，现有数据越来越多。最后，入院前衰弱与危重病后的不良长期结局相关；需要更多数据来评估危重病对衰弱个体健康轨迹的可归因影响。
总结
年龄、合并症和衰弱在决定需要重症监护的患者的长期结局中起关键作用。
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