两种危重症患者衰弱识别工具的比较：一项多中心前瞻性队列研究的事后分析。
Comparison of two frailty identification tools for critically ill patients: A post-hoc analysis of a multicenter prospective cohort study.
机构信息
Hospital Sírio Libanês, Rua Daher Cutait 69, 01308-060 São Paulo, Brazil; Emergency Medicine Discipline, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Av Enéas de Carvalho Aguiar 255 Sala 5023, 05403-000 São Paulo, Brazil; Brazilian Research in Intensive Care Network (BRICNet), São Paulo, Brazil.
Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, 2C Area, L8S 4K1 Hamilton, Canada.
出版信息
J Crit Care. 2020 Oct;59:143-148. doi: 10.1016/j.jcrc.2020.06.007. Epub 2020 Jul 1.
PURPOSE
We aimed to describe the association of two frailty screening tools, the validated Clinical Frailty Scale (CFS) score and the recently described modified Frailty Index (mFI) in critically ill patients.
MATERIALS AND METHODS
We performed a post-hoc analysis of a multicenter cohort of patients admitted to six Canadian Intensive Care Units (ICU) between 2010 and 2011. Frailty was screened using the CFS and the mFI. Concordance between these tools was evaluated, as well as discrimination and predictive ability for clinical outcomes after adjustments.
RESULTS
The cohort included 421 patients. Prevalence of frailty was 32.8% with the CFS and 39.2% with the mFI. However, concordance between the two tools was low [(intraclass correlation of 0.37; 95% confidence interval [CI] 0.29-0.45) and partial Spearman rank correlation of 0.38 (95% CI 0.29-0.47)]. Hospital and 1-year mortality, as well as dependency after discharge and hospital readmission, were greater for frail compared to non-frail patients screened with the use of both tools.
CONCLUSION
While the CFS and mFI showed low concordance, both showed good discrimination and predictive validity for hospital mortality. Both tools identify a subgroup of frail patients more likely to have worse clinical outcomes.
目的
我们旨在描述两种虚弱筛查工具，即经过验证的临床虚弱量表（CFS）评分和最近描述的改良虚弱指数（mFI），在危重症患者中的关联。
材料和方法
我们对 2010 年至 2011 年间在加拿大六家重症监护病房（ICU）入院的多中心队列患者进行了一项回顾性分析。使用 CFS 和 mFI 对虚弱进行筛查。评估了这些工具之间的一致性，以及在调整后对临床结局的判别能力和预测能力。
结果
该队列包括 421 名患者。CFS 检测的虚弱患病率为 32.8%，mFI 为 39.2%。然而，两种工具之间的一致性较低[（组内相关系数为 0.37；95%置信区间 [CI] 0.29-0.45）和部分斯皮尔曼等级相关系数为 0.38（95% CI 0.29-0.47）]。与使用两种工具筛查的非虚弱患者相比，虚弱患者的住院和 1 年死亡率以及出院后依赖和再次住院率更高。
结论
虽然 CFS 和 mFI 显示出较低的一致性，但两者均显示出对住院死亡率的良好判别能力和预测有效性。两种工具都确定了一个更可能出现不良临床结局的虚弱患者亚组。
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