Division of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
Department of Cardiology, Charité - University Hospital, Berlin, Germany.
BMC Geriatr. 2018 Jul 13;18(1):162. doi: 10.1186/s12877-018-0847-7.
In intensive care units (ICU) octogenarians become a routine patients group with aggravated therapeutic and diagnostic decision-making. Due to increased mortality and a reduced quality of life in this high-risk population, medical decision-making a fortiori requires an optimum of risk stratification. Recently, the VIP-1 trial prospectively observed that the clinical frailty scale (CFS) performed well in ICU patients in overall-survival and short-term outcome prediction. However, it is known that healthcare systems differ in the 21 countries contributing to the VIP-1 trial. Hence, our main focus was to investigate whether the CFS is usable for risk stratification in octogenarians admitted to diversified and high tech German ICUs.
This multicentre prospective cohort study analyses very old patients admitted to 20 German ICUs as a sub-analysis of the VIP-1 trial. Three hundred and eight patients of 80 years of age or older admitted consecutively to participating ICUs. CFS, cause of admission, APACHE II, SAPS II and SOFA scores, use of ICU resources and ICU- and 30-day mortality were recorded. Multivariate logistic regression analysis was used to identify factors associated with 30-day mortality.
Patients had a median age of 84 [IQR 82-87] years and a mean CFS of 4.75 (± 1.6 standard-deviation) points. More than half of the patients (53.6%) were classified as frail (CFS ≥ 5). ICU-mortality was 17.3% and 30-day mortality was 31.2%. The cause of admission (planned vs. unplanned), (OR 5.74) and the CFS (OR 1.44 per point increase) were independent predictors of 30-day survival.
The CFS is an easy determinable valuable tool for prediction of 30-day ICU survival in octogenarians, thus, it may facilitate decision-making for intensive care givers in Germany.
The VIP-1 study was retrospectively registered on ClinicalTrials.gov (ID: NCT03134807 ) on May 1, 2017.
在重症监护病房（ICU）中，80 岁以上的老年人成为常规患者群体，治疗和诊断决策变得更加复杂。由于该高风险人群的死亡率增加和生活质量降低，医疗决策尤其需要进行最佳风险分层。最近，VIP-1 试验前瞻性观察到，临床虚弱量表（CFS）在 ICU 患者的总体生存和短期预后预测中表现良好。然而，已知参与 VIP-1 试验的 21 个国家的医疗保健系统存在差异。因此，我们的主要重点是研究 CFS 是否可用于德国多样化和高科技 ICU 收治的 80 岁以上老年人的风险分层。
这项多中心前瞻性队列研究分析了 VIP-1 试验中的一个亚组，即连续收治于 20 家德国 ICU 的 308 名 80 岁或 80 岁以上的老年患者。记录患者的 CFS、入院原因、急性生理学和慢性健康评估 II 评分（APACHE II）、简化急性生理学评分 II 评分（SAPS II）和序贯器官衰竭评估评分（SOFA）、ICU 资源使用情况以及 ICU 住院和 30 天死亡率。采用多变量逻辑回归分析确定与 30 天死亡率相关的因素。
患者的中位年龄为 84 [IQR 82-87] 岁，平均 CFS 为 4.75（±1.6 标准差）分。超过一半的患者（53.6%）被归类为虚弱（CFS≥5）。ICU 死亡率为 17.3%，30 天死亡率为 31.2%。入院原因（计划性与非计划性）（OR 5.74）和 CFS（每增加 1 分的 OR 1.44）是 30 天生存的独立预测因素。
CFS 是预测 80 岁以上老年人 30 天 ICU 生存率的一种易于确定的有价值的工具，因此，它可能有助于德国的重症监护提供者做出决策。
VIP-1 研究于 2017 年 5 月 1 日在 ClinicalTrials.gov 上进行了回顾性注册（ID：NCT03134807）。
