85 岁以上重症监护患者的术前功能状态作为预后预测指标。
Premorbid functional status as an outcome predictor in intensive care patients aged over 85 years.
机构信息
University of Eastern Finland and Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland.
Division of Intensive Care Medicine, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
出版信息
BMC Geriatr. 2022 Jan 10;22(1):38. doi: 10.1186/s12877-021-02746-1.
BACKGROUND
Poor premorbid functional status (PFS) is associated with mortality after intensive care unit (ICU) admission in patients aged 80 years or older. In the subgroup of very old ICU patients, the ability to recover from critical illness varies irrespective of age. To assess the predictive ability of PFS also among the patients aged 85 or older we set out the current study.
METHODS
In this nationwide observational registry study based on the Finnish Intensive Care Consortium database, we analysed data of patients aged 85 years or over treated in ICUs between May 2012 and December 2015. We defined PFS as good for patients who had been independent in activities of daily living (ADL) and able to climb stairs and as poor for those who were dependent on help or unable to climb stairs. To assess patients' functional outcome one year after ICU admission, we created a functional status score (FSS) based on how many out of five physical activities (getting out of bed, moving indoors, dressing, climbing stairs, and walking 400 m) the patient could manage. We also assessed the patients' ability to return to their previous type of accommodation.
RESULTS
Overall, 2037 (3.3% of all adult ICU patients) patients were 85 years old or older. The average age of the study population was 87 years. Data on PFS were available for 1446 (71.0%) patients (good for 48.8% and poor for 51.2%). The one-year mortalities of patients with good and those with poor PFS were 29.2% and 50.1%, respectively, p < 0.001. Poor PFS increased the probability of death within 12 months, adjusted odds ratio (OR), 2.15; 95% confidence interval (CI) 1.68-2.76, p < 0.001. For 69.5% of survivors, the FSS one year after ICU admission was unchanged or higher than their premorbid FSS and 84.2% of patients living at home before ICU admission still lived at home.
CONCLUSIONS
Poor PFS doubled the odds of death within one year. For most survivors, functional status was comparable to the premorbid status.
背景
在 80 岁及以上的重症监护病房（ICU）患者中，较差的发病前功能状态（PFS）与死亡率相关。在非常高龄的 ICU 患者亚组中，无论年龄大小，从危重病中恢复的能力都各不相同。为了评估 85 岁及以上患者的 PFS 的预测能力，我们开展了目前的研究。
方法
本研究为基于芬兰重症监护联合会数据库的全国性观察性注册研究，分析了 2012 年 5 月至 2015 年 12 月在 ICU 接受治疗的 85 岁及以上患者的数据。我们将日常生活活动（ADL）独立且能够上下楼梯的患者定义为 PFS 良好，将依赖帮助或无法上下楼梯的患者定义为 PFS 差。为了评估 ICU 入院后 1 年患者的功能结局，我们根据患者能够完成的 5 项身体活动（起床、在室内移动、穿衣、爬楼梯和行走 400 米）的数量创建了一个功能状态评分（FSS）。我们还评估了患者返回之前居住类型的能力。
结果
总体而言，2037 名（所有成人 ICU 患者的 3.3%）患者年龄在 85 岁及以上。研究人群的平均年龄为 87 岁。1446 名（71.0%）患者有 PFS 数据（良好占 48.8%，差占 51.2%）。PFS 良好和差的患者 1 年死亡率分别为 29.2%和 50.1%，p<0.001。较差的 PFS 增加了 12 个月内死亡的概率，调整后的优势比（OR）为 2.15；95%置信区间（CI）为 1.68-2.76，p<0.001。对于 69.5%的幸存者，ICU 入院后 1 年的 FSS 与发病前的 FSS 相同或更高，84.2%在 ICU 入院前居住在家中的患者仍居住在家中。
结论
较差的 PFS 使 1 年内死亡的风险增加了一倍。对于大多数幸存者，功能状态与发病前状态相当。
Zotero 插件