Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Crit Care. 2021 Apr 19;25(1):149. doi: 10.1186/s13054-021-03551-3.
The COVID-19 pandemic has led highly developed healthcare systems to the brink of collapse due to the large numbers of patients being admitted into hospitals. One of the potential prognostic indicators in patients with COVID-19 is frailty. The degree of frailty could be used to assist both the triage into intensive care, and decisions regarding treatment limitations. Our study sought to determine the interaction of frailty and age in elderly COVID-19 ICU patients.
A prospective multicentre study of COVID-19 patients ≥ 70 years admitted to intensive care in 138 ICUs from 28 countries was conducted. The primary endpoint was 30-day mortality. Frailty was assessed using the clinical frailty scale. Additionally, comorbidities, management strategies and treatment limitations were recorded.
The study included 1346 patients (28% female) with a median age of 75 years (IQR 72-78, range 70-96), 16.3% were older than 80 years, and 21% of the patients were frail. The overall survival at 30 days was 59% (95% CI 56-62), with 66% (63-69) in fit, 53% (47-61) in vulnerable and 41% (35-47) in frail patients (p < 0.001). In frail patients, there was no difference in 30-day survival between different age categories. Frailty was linked to an increased use of treatment limitations and less use of mechanical ventilation. In a model controlling for age, disease severity, sex, treatment limitations and comorbidities, frailty was independently associated with lower survival.
Frailty provides relevant prognostic information in elderly COVID-19 patients in addition to age and comorbidities. Trial registration Clinicaltrials.gov: NCT04321265 , registered 19 March 2020.
由于大量患者住院，COVID-19 大流行使高度发达的医疗体系濒临崩溃。COVID-19 患者的一个潜在预后指标是虚弱。虚弱程度可用于协助重症监护的分诊和治疗限制决策。我们的研究旨在确定 COVID-19 老年 ICU 患者中虚弱和年龄的相互作用。
对 28 个国家的 138 个 ICU 收治的≥70 岁 COVID-19 患者进行前瞻性多中心研究。主要终点是 30 天死亡率。使用临床虚弱量表评估虚弱。此外，还记录了合并症、管理策略和治疗限制。
该研究纳入了 1346 名患者（28%为女性），中位年龄为 75 岁（IQR 72-78，范围 70-96），16.3%年龄大于 80 岁，21%的患者虚弱。30 天总体生存率为 59%（95%CI 56-62），健康组为 66%（63-69），脆弱组为 53%（47-61），虚弱组为 41%（35-47）（p<0.001）。在虚弱患者中，不同年龄组的 30 天生存率无差异。虚弱与治疗限制的使用增加和机械通气的使用减少有关。在控制年龄、疾病严重程度、性别、治疗限制和合并症的模型中，虚弱与较低的生存率独立相关。
除年龄和合并症外，虚弱为老年 COVID-19 患者提供了相关的预后信息。试验注册Clinicaltrials.gov：NCT04321265，于 2020 年 3 月 19 日注册。
