Department of Critical Care Medicine, Faculty of Medicine and Dentistry and School of Public Health, University of Alberta, 2-124E Clinical Sciences Building, 8440-112 St NW, Edmonton, AB, T6G 2B7, Canada.
Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
Can J Anaesth. 2019 Nov;66(11):1310-1319. doi: 10.1007/s12630-019-01414-8. Epub 2019 May 29.
A substantial proportion of patients admitted to intensive care units (ICUs) are frail; however, the epidemiology of frailty has not been explored at a population-level. Following implementation of a validated frailty measure into a provincial ICU clinical information system, we describe the population-based prevalence and outcomes of frailty in patients admitted to ICUs.
Retrospective cohort study of adult admissions to 17 ICUs. Data were captured using eCritical Alberta. A Clinical Frailty Scale (CFS) score assigned at ICU admission was used to define the exposure (CFS score ≥ 5). Primary outcome was hospital mortality. Secondary outcomes were ICU and hospital stay, and receipt of organ support.
Fifteen thousand two hundred and thirty-eight patients (81%) were assigned a CFS score at ICU admission. Of these, 28% (95% confidence interval [CI], 27 to 28) were frail. Prevalence of frailty was 9-43% across ICUs. Frail patients were older [mean (standard deviation) 63 (15) vs 56 (17) yr; P < 0.001], more likely to be male (54% vs 46% female; P < 0.001), and had higher APACHE II scores [22 (8) vs 17 (8); P < 0.001] compared with non-frail patients. Frail patients received less mechanical ventilation (62% vs 68%; P < 0.001) and vasoactive therapy (24% vs 57%; P < 0.001), but more non-invasive ventilation (22% vs 9%; P < 0.001). Frail patients had higher hospital mortality (23% vs 9%; adjusted odds ratio, 1.80; 95% CI, 1.64 to 2.05, along with longer ICU stay (median [interquartile range] 4 [2-8] vs 3 [2-6] days; P < 0.001), and longer hospital stay (16 [8-36] vs 10 [5-20] days; P < 0.001) compared with non-frail patients.
A validated measure of frailty can be implemented at the population level in ICU. Frailty is common in ICU patients and has implications for health service use and clinical outcomes.
大量入住重症监护病房（ICU）的患者身体虚弱；然而，人群中虚弱的流行病学尚未得到探索。在省级 ICU 临床信息系统中实施经过验证的虚弱评估工具后，我们描述了 ICU 患者中虚弱的人群患病率和结局。
对 17 个 ICU 成人住院患者进行回顾性队列研究。使用 eCritical Alberta 捕获数据。在 ICU 入院时分配的临床虚弱量表（CFS）评分用于定义暴露（CFS 评分≥5）。主要结局是院内死亡率。次要结局为 ICU 和住院时间，以及器官支持的使用。
15238 名患者（81%）在 ICU 入院时被分配了 CFS 评分。其中，28%（95%置信区间[CI]，27 至 28）为虚弱。各 ICU 虚弱的患病率为 9%至 43%。虚弱患者年龄较大[平均（标准差）63（15）比 56（17）岁；P<0.001]，更可能为男性（54%比 46%女性；P<0.001），且急性生理学和慢性健康评估 II 评分较高[22（8）比 17（8）；P<0.001]与非虚弱患者相比。虚弱患者接受的机械通气（62%比 68%；P<0.001）和血管活性治疗（24%比 57%；P<0.001）较少，但接受的无创通气更多（22%比 9%；P<0.001）。虚弱患者的院内死亡率较高（23%比 9%；调整后的优势比，1.80；95%CI，1.64 至 2.05），ICU 入住时间更长（中位数[四分位距]4[2-8]比 3[2-6]天；P<0.001），住院时间更长（16[8-36]比 10[5-20]天；P<0.001）与非虚弱患者相比。
可以在 ICU 人群中实施经过验证的虚弱评估工具。虚弱在 ICU 患者中很常见，对卫生服务的使用和临床结局有影响。
