Stefan Mihaela, Asghar Aleezay, Shieh Meng-Shiou, Demir-Yavuz Selma, Steingrub Jay S
Department of Medicine, University of Massachusetts (UMass) Chan Medical School - Baystate Medical Center, Springfield, USA.
Department of Internal Medicine, University of Massachusetts (UMass) Chan Medical School - Baystate Medical Center, Springfield, USA.
Cureus. 2022 Dec 30;14(12):e33143. doi: 10.7759/cureus.33143. eCollection 2022 Dec.
The objective of this study was to investigate the prevalence and impact of frailty on mortality in patients with acute respiratory failure (ARF) treated with noninvasive ventilation (NIV). This was a single-center, prospective study of patients who developed ARF (irrespective of etiology) and were treated with NIV support. Frailty was assessed using the Clinical Frailty Scale (CFS). We modeled the relationship of CFS with one-year mortality using Cox proportional hazards regression, adjusting for other clinical and demographic characteristics. Of the 166 patients enrolled, 48% had moderate to severe frailty. These patients were more likely to be female (67% versus 33%) and on oxygen therapy at home (46% versus 28%). The median CFS score was 5 (interquartile range (IQR): 5-6). Moderate to severe frailty was associated with a 60% higher risk of one-year mortality (hazard ratio (HR): 1.63, 95% confidence interval (CI): 1.15-2.31). Frailty assessment may identify patients in need of ventilatory support who are at increased risk of mortality and may be an important factor to consider when discussing goals of care in this vulnerable population.
本研究的目的是调查急性呼吸衰竭（ARF）患者接受无创通气（NIV）治疗时衰弱的患病率及其对死亡率的影响。这是一项针对发生ARF（不论病因）并接受NIV支持治疗患者的单中心前瞻性研究。使用临床衰弱量表（CFS）评估衰弱情况。我们采用Cox比例风险回归模型，对CFS与一年死亡率之间的关系进行建模，并对其他临床和人口统计学特征进行调整。在纳入的166例患者中，48%有中度至重度衰弱。这些患者更可能为女性（67%对33%）且在家接受氧疗（46%对28%）。CFS评分中位数为5（四分位间距（IQR）：5 - 6）。中度至重度衰弱与一年死亡率风险高60%相关（风险比（HR）：1.63，95%置信区间（CI）：1.15 - 2.31）。衰弱评估可能识别出需要通气支持且死亡风险增加的患者，并且在讨论这一脆弱人群的治疗目标时可能是一个需要考虑的重要因素。
