Fuest K E, Lorenz Marco, Grunow Julius J, Weiss Björn, Mörgeli Rudolf, Finkenzeller Sebastian, Bogdanski Ralph, Heim Markus, Kapfer Barbara, Kriescher Silja, Lingg Charlotte, Martin Jan, Ulm Bernhard, Jungwirth Bettina, Blobner Manfred, Schaller Stefan J
Department of Anesthesiology and Intensive Care, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
Department of Anesthesiology and Operative Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Front Med (Lausanne). 2021 Nov 4;8:748812. doi: 10.3389/fmed.2021.748812. eCollection 2021.
Long-term outcome is determined not only by the acute critical illness but increasingly by the reduced functional reserve of pre-existing frailty. The patients with frailty currently account for one-third of the critically ill, resulting in higher mortality. There is evidence of how frailty affects the intrahospital functional trajectory of critically ill patients since prehospital status is often missing. In this prospective single-center cohort study at two interdisciplinary intensive care units (ICUs) at a university hospital in Germany, the frailty was assessed using the Clinical Frailty Scale (CFS) in the adult patients with critical illness with an ICU stay >24 h. The functional status was assessed using the sum of the subdomains "Mobility" and "Transfer" of the Barthel Index (MTB) at three time points (pre-hospital, ICU discharge, and hospital discharge). We included 1,172 patients with a median age of 75 years, of which 290 patients (25%) were frail. In a propensity score-matched cohort, the probability of MTB deterioration till hospital discharge did not differ in the patients with frailty (odds ratio () 1.3 [95% 0.8-1.9], = 0.301), confirmed in several sensitivity analyses in all the patients and survivors only. The patients with frailty have a reduced functional status. Their intrahospital functional trajectory, however, was not worse than those in non-frail patients, suggesting a rehabilitation potential of function in critically ill patients with frailty.
长期预后不仅取决于急性危重病,还越来越多地取决于先前存在的虚弱状态导致的功能储备下降。目前,虚弱患者占危重病患者的三分之一,导致更高的死亡率。由于院前状态往往缺失,有证据表明虚弱如何影响危重病患者的院内功能轨迹。在德国一家大学医院的两个跨学科重症监护病房(ICU)进行的这项前瞻性单中心队列研究中,使用临床虚弱量表(CFS)对入住ICU超过24小时的成年危重病患者进行虚弱评估。在三个时间点(院前、ICU出院和医院出院),使用巴氏指数(MTB)的“活动能力”和“转移能力”子领域的总和来评估功能状态。我们纳入了1172例患者,中位年龄为75岁,其中290例患者(25%)虚弱。在倾向评分匹配队列中,虚弱患者直至医院出院时MTB恶化的概率没有差异(优势比(OR)1.3[95%置信区间0.8 - 1.9],P = 0.301),在所有患者及仅幸存者的多项敏感性分析中得到证实。虚弱患者的功能状态较差。然而,他们的院内功能轨迹并不比非虚弱患者差,这表明虚弱的危重病患者具有功能康复潜力。