FRAIL-FIT研究：重症监护病房治疗一年后，虚弱与长期不良事件发生率的关系——一项回顾性观察队列研究。
The FRAIL-FIT study: Frailty's relationship with adverse-event incidence in the longer term, at one year following intensive care unit treatment - A retrospective observational cohort study.
作者信息
Hewitt David, Booth Malcolm G
机构信息
University of Glasgow, Glasgow, UK.
Glasgow Royal Infirmary Intensive Care Unit, Glasgow, UK.
出版信息
J Intensive Care Soc. 2020 May;21(2):124-133. doi: 10.1177/1751143719838212. Epub 2019 May 14.
INTRODUCTION
Frailty is a syndrome of decreased reserve and heightened vulnerability. Frailty scoring has potential to facilitate more informed decisions in the intensive care unit. To validate this, its relationship with outcomes must be tested extensively. This study aimed to investigate frailty's impact on adverse outcomes after intensive care unit admission, primarily one-year mortality.
METHODS
This single-centre retrospective observational cohort study examined prospectively collected data from 400 intensive care unit patients. Frailty was assessed using the Clinical Frailty Scale and defined as Clinical Frailty Scale ≥ 5. Unadjusted and adjusted analyses tested the relationships of frailty, covariates and outcomes.
RESULTS
Of 400 eligible patients, 111 (27.8%) were frail and 289 (72.3%) were non-frail. Compared to non-frail patients, frail patients were older (62 vs. 56, p < 0.001) and had higher Acute Physiology and Chronic Health Evaluation II scores (22 vs. 19, p < 0.001). Females were more likely to be frail than males (34.1% vs. 22.9% frail, p = 0.018). Frail patients were less likely to survive the intensive care unit (p = 0.03), hospital (p = 0.003) or to one year (p < 0.001). Frailty significantly increased one-year mortality hazards in unadjusted analyses (hazard ratio 1.96; 95% confidence interval 1.41-2.72; p < 0.001) and covariate adjusted analyses (hazard ratio 1.41; 95% confidence interval 1.00-1.98; p = 0.0497). Frail patients had more hospital admissions (p = 0.014) and longer hospital stays within both one year before (p = 0.002) and one year after intensive care unit admission (p = 0.012).
CONCLUSIONS
Frailty was common and associated with greater age, female gender, higher sickness severity and more healthcare use. Frailty was significantly associated with greater risks of mortality in both unadjusted and adjusted analyses. Frailty scoring is a promising tool which could improve decision making in intensive care.
引言
衰弱是一种储备能力下降和易损性增加的综合征。衰弱评分有可能在重症监护病房促成更明智的决策。为了验证这一点，必须广泛测试其与预后的关系。本研究旨在调查衰弱对重症监护病房入院后不良预后的影响，主要是一年死亡率。
方法
这项单中心回顾性观察队列研究检查了前瞻性收集的400例重症监护病房患者的数据。使用临床衰弱量表评估衰弱情况，并将其定义为临床衰弱量表≥5。未调整和调整后的分析测试了衰弱、协变量与预后之间的关系。
结果
在400例符合条件的患者中，111例（27.8%）为衰弱患者，289例（72.3%）为非衰弱患者。与非衰弱患者相比，衰弱患者年龄更大（62岁对56岁，p<0.001），急性生理与慢性健康状况评价II评分更高（22对19，p<0.001）。女性比男性更易衰弱（衰弱比例分别为34.1%对22.9%，p=0.018）。衰弱患者在重症监护病房存活的可能性较小（p=0.03），在医院存活的可能性较小（p=0.003），活到一年的可能性较小（p<0.001）。在未调整分析中，衰弱显著增加一年死亡风险（风险比1.96；95%置信区间1.41-2.72；p<0.001），在协变量调整分析中也是如此（风险比1.41；95%置信区间1.00-1.98；p=0.0497）。衰弱患者在重症监护病房入院前一年（p=0.002）和入院后一年（p=0.012）内住院次数更多（p=0.014），住院时间更长。
结论
衰弱很常见，且与年龄较大、女性、疾病严重程度较高和医疗保健使用较多有关。在未调整和调整后的分析中，衰弱均与更高的死亡风险显著相关。衰弱评分是一种有前景的工具，可改善重症监护中的决策制定。
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