Department of Anaesthesiology, Kuopio University Hospital, P.O. Box 100, 70029, Kuopio, Finland.
Division of Intensive Care Medicine, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Intensive Care Med. 2018 Aug;44(8):1221-1229. doi: 10.1007/s00134-018-5273-y. Epub 2018 Jul 2.
We assessed the association between the premorbid functional status (PFS) and 1-year mortality and functional status of very old intensive care patients.
Using a nationwide quality registry, we retrieved data on patients treated in Finnish intensive care units (ICUs) during the period May 2012‒April 2013. Of 16,389 patients, 1827 (11.1%) were very old (aged 80 years or older). We defined a person with good functional status as someone independent in activities of daily living (ADL) and able to climb stairs without assistance; a person with poor functional status was defined as needing assistance for ADL or being unable to climb stairs. We adjusted for severity of illness and calculated the impact of PFS.
Overall, hospital mortality was 21.3% and 1-year mortality was 38.2%. For emergency patients (73.5% of all), hospital mortality was 28% and 1-year mortality was 48%. The functional status at 1 year was comparable to the PFS in 78% of the survivors. PFS was poor for 43.3% of the patients. A poor PFS predicted an increased risk of in-hospital death, adjusted odds ratio (OR) 1.50 (95% confidence interval, 1.07-2.10), and of 1-year mortality, OR 2.18 (1.67-2.85). PFS data significantly improved the prediction of 1-year mortality.
Of very old ICU patients, 62% were alive 1 year after ICU admission and 78% of the survivors had a functional status comparable to the premorbid situation. A poor PFS doubled the odds of death within a year. Knowledge of PFS improved the prediction of 1-year mortality.
评估病前功能状态（PFS）与非常老年重症监护患者 1 年死亡率和功能状态之间的关系。
使用全国性质量登记处，我们检索了 2012 年 5 月至 2013 年 4 月期间在芬兰重症监护病房（ICU）接受治疗的患者数据。在 16389 名患者中，1827 名（11.1%）为非常老年（年龄 80 岁或以上）。我们将日常生活活动（ADL）自理且无需帮助即可爬楼梯的人定义为功能状态良好的人；将需要 ADL 帮助或无法爬楼梯的人定义为功能状态较差的人。我们调整了疾病严重程度，并计算了 PFS 的影响。
总体而言，住院死亡率为 21.3%，1 年死亡率为 38.2%。对于急症患者（所有患者的 73.5%），住院死亡率为 28%，1 年死亡率为 48%。在幸存者中，78%的患者 1 年后的功能状态与 PFS 相当。43.3%的患者 PFS 较差。较差的 PFS 预示着住院死亡风险增加，调整后的优势比（OR）为 1.50（95%置信区间，1.07-2.10），1 年死亡率的 OR 为 2.18（1.67-2.85）。PFS 数据显著提高了 1 年死亡率的预测能力。
在非常老年的 ICU 患者中，62%在 ICU 入院后 1 年内存活，78%的幸存者的功能状态与病前情况相当。较差的 PFS 使 1 年内死亡的可能性增加了一倍。对 PFS 的了解提高了对 1 年死亡率的预测能力。
