Research Institute, HCor-Hospital do Coração, São Paulo, Brazil.
ICU, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil.
Intensive Care Med. 2018 Sep;44(9):1512-1520. doi: 10.1007/s00134-018-5342-2. Epub 2018 Aug 13.
Frail patients are known to experience poor outcomes. Nevertheless, we know less about how frailty manifests itself in patients' physiology during critical illness and how it affects resource use in intensive care units (ICU). We aimed to assess the association of frailty with short-term outcomes and organ support used by critically ill patients.
Retrospective analysis of prospective collected data from 93 ICUs in Brazil from 2014 to 2015. We assessed frailty using the modified frailty index (MFI). The primary outcome was in-hospital mortality. Secondary outcomes were discharge home without need for nursing care, ICU and hospital length of stay (LOS), and utilization of ICU organ support and transfusion. We used mixed logistic regression and competing risk models accounting for relevant confounders in outcome analyses.
The analysis consisted of 129,680 eligible patients. There were 40,779 (31.4%) non-frail (MFI = 0), 64,407 (49.7%) pre-frail (MFI = 1-2) and 24,494 (18.9%) frail (MFI ≥ 3) patients. After adjusted analysis, frailty was associated with higher in-hospital mortality (OR 2.42, 95% CI 1.89-3.08), particularly in patients admitted with lower SOFA scores. Frail patients were less likely to be discharged home (OR 0.36, 95% CI 0.54-0.79) and had higher hospital and ICU LOS than non-frail patients. Use of all forms of organ support (mechanical ventilation, non-invasive ventilation, vasopressors, dialysis and transfusions) were more common in frail patients and increased as MFI increased.
Frailty, as assessed by MFI, was associated with several patient-centered endpoints including not only survival, but also ICU LOS and organ support.
众所周知，虚弱的患者预后较差。然而，我们对危重病患者生理机能中的脆弱表现以及它如何影响重症监护病房（ICU）资源利用知之甚少。我们旨在评估脆弱性与危重病患者短期预后和器官支持使用之间的关系。
对 2014 年至 2015 年巴西 93 个 ICU 的前瞻性收集数据进行回顾性分析。我们使用改良的脆弱性指数（MFI）评估脆弱性。主要结局是住院死亡率。次要结局是无需护理即可出院、ICU 和住院时间（LOS）、以及 ICU 器官支持和输血的使用。我们使用混合逻辑回归和竞争风险模型，在结局分析中考虑了相关的混杂因素。
分析包括 129680 名符合条件的患者。无脆弱性（MFI=0）患者 40779 例（31.4%），脆弱前（MFI=1-2）患者 64407 例（49.7%），脆弱（MFI≥3）患者 24494 例（18.9%）。经过调整分析，脆弱性与更高的住院死亡率相关（OR 2.42，95%CI 1.89-3.08），尤其是在 SOFA 评分较低的患者中。脆弱患者出院回家的可能性较低（OR 0.36，95%CI 0.54-0.79），与非脆弱患者相比，住院和 ICU LOS 更长。所有形式的器官支持（机械通气、无创通气、血管加压素、透析和输血）在脆弱患者中更为常见，并且随着 MFI 的增加而增加。
MFI 评估的脆弱性与包括生存率在内的多个以患者为中心的结局相关，还与 ICU LOS 和器官支持相关。
