Division of anesthesiology, Département of anesthesiology, Hospital Riviera Chablais, Vaud Valais, Rennaz, Switzerland.
Divison of Internal Medecine of the Aged, Departement of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland.
BMC Geriatr. 2020 Sep 9;20(1):334. doi: 10.1186/s12877-020-01729-y.
Age alone is not a robust predictor of mortality in critically ill elderly patients. Chronic health status and functional status before admission could be better predictors. This study aimed to determine whether functional status, assessed using the Functional Independence Measure (FIM), could be an independent predictor of mortality in a geriatric population admitted to an intermediate care unit (IMCU).
A monocentric, retrospective, observational study of all patients aged ≥75 years old admitted to Geneva University Hospitals' geriatric IMCU between 01.01.2012 and 31.05.2016. The study's primary outcome metrics were one-year mortality's associations with a pre-admission FIM score and other relevant prospectively recorded prognostic variables.
A total of 345 patients were included (56% female, mean age 85 +/- 6.5 years). Mean FIM score was 66 +/- 26. One-year mortality was 57%. Dichotomized low (≤ 63) and high FIM (> 63) scores were associated with one-year mortalities of 68 and 44%, respectively. Logistic regression calculations found an association between pre-admission FIM score and one-year mortality (p < 0.0001), including variables usually associated with mortality (e.g., age, sex, comorbidities, mini-mental health state score, renal function). Multivariate survival analysis showed a significant difference between groups, with a hazard ratio of 0.29 (95% CI: 0.13-0.65) for patients with high FIM scores.
In the present study, higher functional status, assessed using the FIM tool before admission to an IMCU, was significantly and independently associated with lower one-year mortality. This opens up perspectives on the potential value of FIM for establishing a finer prognosis and better triage of critically ill older patients.
年龄本身并不是危重症老年患者死亡率的可靠预测因素。入院前的慢性健康状况和功能状态可能是更好的预测因素。本研究旨在确定功能状态（使用功能独立性测量（FIM）评估）是否可以作为入住老年重症监护病房（IMCU）的老年人群死亡率的独立预测因素。
这是一项单中心、回顾性、观察性研究，纳入了 2012 年 1 月 1 日至 2016 年 5 月 31 日期间入住日内瓦大学医院老年 IMCU 的所有年龄≥75 岁的患者。该研究的主要结局指标是入院前 FIM 评分与其他相关前瞻性记录的预后变量与一年死亡率的相关性。
共纳入 345 例患者（56%为女性，平均年龄 85 +/- 6.5 岁）。平均 FIM 评分为 66 +/- 26。一年死亡率为 57%。低（≤ 63）和高 FIM（> 63）评分的二分法与一年死亡率分别为 68%和 44%相关。逻辑回归计算发现入院前 FIM 评分与一年死亡率之间存在关联（p < 0.0001），包括通常与死亡率相关的变量（例如年龄、性别、合并症、简易精神状态量表、肾功能）。多变量生存分析显示两组之间存在显著差异，FIM 评分高的患者风险比为 0.29（95%CI：0.13-0.65）。
在本研究中，入院前使用 FIM 工具评估的更高功能状态与较低的一年死亡率显著且独立相关。这为 FIM 在建立更精细的预后和更好地对危重症老年患者进行分诊方面的潜在价值提供了新的视角。
