在波兰重症监护病房接受治疗的80岁及以上患者中，虚弱与死亡率增加有关。

Frailty is associated with an increased mortality among patients ≥ 80 years old treated in Polish ICUs.

作者信息

Fronczek Jakub, Polok Kamil Jurand, Nowak-Kózka Ilona, Włudarczyk Anna, Górka Jacek, Czuczwar Mirosław, Krawczyk Paweł, Ziętkiewicz Mirosław, Nowak Łukasz R, Żukowski Maciej, Kotfis Katarzyna, Cwyl Katarzyna, Gajdosz Ryszard, Bohatyrewicz Romuald, Biernawska Jowita, Grudzień Paweł, Nasiłowski Paweł, Popek Natalia, Cyrankiewicz Waldemar, Wawrzyniak Katarzyna, Wnuk Marek, Maciejewski Dariusz, Studzińska Dorota, Bernas Szymon, Piechota Mariusz, Machała Waldemar, Serwa Marta, Wujtewicz Maria, Stefaniak Jan, Szymkowiak Małgorzata, Gawda Ryszard, Adamik Barbara, Kozera Natalia, Goździk Waldemar, Flaatten Hans, Szczeklik Wojciech

机构信息

Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Cracow, Poland.

出版信息

Anaesthesiol Intensive Ther. 2018;50(4):245-251. doi: 10.5603/AIT.a2018.0032. Epub 2018 Sep 22.

DOI:10.5603/AIT.a2018.0032

PMID:30242826

Abstract

BACKGROUND

The increasing population of very old intensive care patients (VIPs) is a major challenge currently faced by clinicians and policymakers. Reliable indicators of VIPs' prognosis and purposefulness of their admission to the intensive care unit (ICU) are urgently needed.

METHODS

This is a report from the Polish sample of the VIP1 multicentre cohort study (NCT03134807). Patients ≥ 80 years of age admitted to the ICU were included in the study. Information on the type and reason for admission, demographics, utilisation of ICU procedures, ICU length of stay, organ dysfunction and the decision to apply end-of-life care was collected. The primary objective was to investigate the impact of frailty syndrome on ICU and 30-day survival of VIPs. Frailty was assessed with the Clinical Frailty Scale (≥ 5 points on a scale of 1-9).

RESULTS

We enrolled 272 participants with a median age of 84 (81-87) years. Frailty was diagnosed in 170 (62.5%) patients. The ICU and 30-day survival rates were equal to 54.6% and 47.3% respectively. Three variables were found to significantly increase the odds of death in the ICU in a multiple logistic regression model: SOFA score (OR = 1.16; 95%CI 1.16-1.24), acute mode of admission (OR = 5.1; 95%CI 1.67-15.57) and frailty (OR = 2.25; 95%CI 1.26-4.01).

CONCLUSION

Measuring frailty in critically ill older adults can facilitate making more informed clinical decisions and help avoid futile interventions.

摘要

背景

高龄重症监护患者（VIP）数量的不断增加是临床医生和政策制定者当前面临的一项重大挑战。目前迫切需要可靠的指标来评估VIP的预后以及其入住重症监护病房（ICU）的合理性。

方法

这是VIP1多中心队列研究波兰样本的一份报告（NCT03134807）。纳入研究的患者为入住ICU且年龄≥80岁者。收集了有关入院类型和原因、人口统计学信息、ICU程序的使用情况、ICU住院时长、器官功能障碍以及实施临终关怀的决定等信息。主要目的是研究衰弱综合征对VIP的ICU生存率和30天生存率的影响。采用临床衰弱量表（1 - 9分制中≥5分）评估衰弱情况。

结果

我们纳入了272名参与者，中位年龄为84（81 - 87）岁。170名（62.5%）患者被诊断为衰弱。ICU生存率和30天生存率分别为54.6%和47.3%。在多因素逻辑回归模型中发现有三个变量显著增加了在ICU死亡的几率：序贯器官衰竭评估（SOFA）评分（比值比[OR]=1.16；95%置信区间[CI] 1.16 - 1.24）、急性入院模式（OR = 5.1；95%CI 1.67 - 15.57）以及衰弱（OR = 2.25；95%CI 1.26 - 4.01）。