Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.
Intensive Care Med. 2017 Dec;43(12):1820-1828. doi: 10.1007/s00134-017-4940-8. Epub 2017 Sep 21.
Very old critical ill patients are a rapid expanding group in the ICU. Indications for admission, triage criteria and level of care are frequently discussed for such patients. However, most relevant outcome studies in this group frequently find an increased mortality and a reduced quality of life in survivors. The main objective was to study the impact of frailty compared with other variables with regards to short-term outcome in the very old ICU population.
A transnational prospective cohort study from October 2016 to May 2017 with 30 days follow-up was set up by the European Society of Intensive Care Medicine. In total 311 ICUs from 21 European countries participated. The ICUs included the first consecutive 20 very old (≥ 80 years) patients admitted to the ICU within a 3-month inclusion period. Frailty, SOFA score and therapeutic procedures were registered, in addition to limitations of care. For measurement of frailty the Clinical Frailty Scale was used at ICU admission. The main outcomes were ICU and 30-day mortality and survival at 30 days.
A total of 5021 patients with a median age of 84 years (IQR 81-86 years) were included in the final analysis, 2404 (47.9%) were women. Admission was classified as acute in 4215 (83.9%) of the patients. Overall ICU and 30-day mortality rates were 22.1% and 32.6%. During ICU stay 23.8% of the patients did not receive specific ICU procedures: ventilation, vasoactive drugs or renal replacement therapy. Frailty (values ≥ 5) was found in 43.1% and was independently related to 30-day survival (HR 1.54; 95% CI 1.38-1.73) for frail versus non-frail.
Among very old patients (≥ 80 years) admitted to the ICU, the consecutive classes in Clinical Frailty Scale were inversely associated with short-term survival. The scale had a very low number of missing data. These findings provide support to add frailty to the clinical assessment in this patient group.
ClinicalTrials.gov (ID: NCT03134807).
非常年老的危重症患者是 ICU 中迅速扩大的群体。对于此类患者，经常讨论其入院适应证、分诊标准和护理水平。然而，该组大多数相关的预后研究发现，存活者的死亡率增加和生活质量降低。主要目的是研究与其他变量相比，衰弱对非常年老的 ICU 人群短期预后的影响。
2016 年 10 月至 2017 年 5 月，欧洲重症监护医学学会进行了一项跨国前瞻性队列研究，为期 30 天。共有来自 21 个欧洲国家的 311 个 ICU 参与。该 ICU 纳入了在 3 个月纳入期内连续收治的前 20 名非常年老（≥80 岁）的 ICU 患者。除了治疗限制外，还登记了衰弱、SOFA 评分和治疗措施。在 ICU 入院时使用临床虚弱量表来测量衰弱。主要结局是 ICU 和 30 天死亡率以及 30 天存活率。
共纳入 5021 名中位年龄为 84 岁（IQR 81-86 岁）的患者进行最终分析，其中 2404 名（47.9%）为女性。4215 名（83.9%）患者的入院被归类为急性。总体 ICU 和 30 天死亡率分别为 22.1%和 32.6%。在 ICU 住院期间，23.8%的患者未接受特定的 ICU 治疗措施：通气、血管活性药物或肾脏替代治疗。发现衰弱（分值≥5）占 43.1%，与虚弱与非虚弱相比，30 天存活率独立相关（HR 1.54；95%CI 1.38-1.73）。
在 ICU 收治的非常年老（≥80 岁）患者中，临床虚弱量表的连续等级与短期存活呈反比。该量表的缺失数据很少。这些发现为在该患者群体中添加衰弱评估提供了支持。
ClinicalTrials.gov（注册号：NCT03134807）。
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