Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH.
Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH.
Crit Care Med. 2020 Oct;48(10):1419-1426. doi: 10.1097/CCM.0000000000004444.
OBJECTIVES: Little is known about frailty that develops following critical illness. We sought to describe the prevalence of newly acquired frailty, its clinical course, and the co-occurrence of frailty with disability and cognitive impairment in survivors of critical illness. DESIGN: Longitudinal prospective cohort study. SETTING: Medical and surgical ICUs at five U.S. centers. PATIENTS: Adult patients treated for respiratory failure and/or shock. MEASUREMENTS AND MAIN RESULTS: We measured frailty with the Clinical Frailty Scale at baseline (i.e., study enrollment) and at 3 and 12 months postdischarge. We constructed alluvial diagrams to describe the course of frailty and Venn diagrams to describe the overlap of frailty with disability in activities of daily living and cognitive impairment. We included 567 participants a median (interquartile range) of 61 years old (51-70 yr old) with a high severity of illness (Acute Physiology and Chronic Health Evaluation II of 23). Frailty (Clinical Frailty Scale scores ≥ 5) was present in 135 of 567 (24%) at baseline, 239 of 530 (45%) at 3 months, and 163 of 445 (37%) at 12 months. Of those with frailty at 3- or 12-month follow-up, 61% were not frail at baseline. Transition to a worse frailty state occurred in 242 of 530 of patients (46%) between baseline and 3 months and in 179 of 445 of patients (40%) between baseline and 12 months. There were 376 patients with frailty, disability, or cognitive impairment at 3-month follow-up. Of these, 53 (14%) had frailty alone. At 12 months, 276 patients had frailty, disability, or cognitive impairment, 37 (13%) of whom had frailty alone. CONCLUSIONS: Frailty is common among survivors of critical illness. In the majority, frailty is newly acquired. Roughly one in seven had frailty without co-occurring disability or cognitive impairment. Studies to understand outcomes of frailty that develops as the result of a critical illness and to identify modifiable risk factors for this potentially reversible syndrome are needed.
目的：人们对危重病后新出现的虚弱知之甚少。我们旨在描述危重病幸存者中新发虚弱的流行情况、其临床病程以及虚弱与残疾和认知障碍的同时发生情况。
设计：纵向前瞻性队列研究。
设置：美国五家中心的内科和外科 ICU。
患者：接受呼吸衰竭和/或休克治疗的成年患者。
测量和主要结果：我们在基线（即研究入组时）以及出院后 3 个月和 12 个月时使用临床虚弱量表测量虚弱情况。我们构建了冲积图来描述虚弱的病程，以及 Venn 图来描述虚弱与日常生活活动中残疾和认知障碍的重叠情况。我们纳入了 567 名参与者，其年龄中位数（四分位距）为 61 岁（51-70 岁），疾病严重程度高（急性生理学和慢性健康评估 II 为 23 分）。567 名患者中有 135 名（24%）在基线时存在虚弱（临床虚弱量表评分≥5），530 名中有 239 名（45%）在 3 个月时，445 名中有 163 名（37%）在 12 个月时。在随访 3 个月或 12 个月时出现虚弱的患者中，有 61%在基线时没有虚弱。在基线至 3 个月期间，530 名患者中有 242 名（46%）虚弱状态恶化，在基线至 12 个月期间，445 名患者中有 179 名（40%）虚弱状态恶化。在 3 个月随访时有 376 名患者出现虚弱、残疾或认知障碍。其中，53 名（14%）仅存在虚弱。在 12 个月时，276 名患者出现虚弱、残疾或认知障碍，其中 37 名（13%）仅存在虚弱。
结论：危重病幸存者中虚弱很常见。在大多数情况下，虚弱是新出现的。大约七分之一的患者存在虚弱但没有同时出现残疾或认知障碍。需要开展研究以了解危重病后新发虚弱的结局，并识别这种潜在可逆转综合征的可改变风险因素。
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