Subramaniam Ashwin, Ling Ryan Ruiyang, Pilcher David
Department of Intensive Care, Peninsula Health, Frankston, Victoria, Australia.
Department of Intensive Care, Dandenong Hospital, Monash Health, Dandenong, Victoria, Australia.
Crit Care Resusc. 2023 Dec 14;26(1):16-23. doi: 10.1016/j.ccrj.2023.11.001. eCollection 2024 Mar.
Though frailty is associated with mortality, its impact on long-term survival after an ICU admission with COVID-19 is unclear. We aimed to investigate the association between frailty and long-term survival in patients after an ICU admission with COVID-19.
This registry-based multicentre, retrospective, cohort study included all patients ≥16 years discharged alive from the hospital following an ICU admission with COVID-19 and documented clinical frailty scale (CFS). Data from 118 ICUs between 01/01/2020 through 31/12/2020 in New Zealand and 31/12/2021 in Australia were reported in the Australian and New Zealand Intensive Care Society Adult Patient Database. The patients were categorised as 'not frail' (CFS 1-3), 'mildly frail' (CFS 4-5) and 'moderately-to-severely frail' (CFS 6-8).
The primary outcome was survival time up to two years, which we analysed using Cox regression models.
We included 4028 patients with COVID-19 in the final analysis. 'Moderately-to-severely frail' patients were older (66.6 [56.3-75.8] vs. 69.9 [60.3-78.1]; p < 0.001) than those without frailty (median [interquartile range] 53.0 [40.1-64.6]), had higher sequential organ failure assessment scores (p < 0.001), and less likely to receive mechanical ventilation (p < 0.001) than patients without frailty or mild frailty. After adjusting for confounders, patients with mild frailty (adjusted hazards ratio: 2.31, 95%-CI: 1.75-3.05) and moderate-to-severe frailty (adjusted hazards ratio: 2.54, 95%-CI: 1.89-3.42) had higher mortality rates than those without frailty.
Frailty was independently associated with shorter survival times to two years in patients with severe COVID-19 in ANZ following hospital discharge. Recognising frailty provides individualised patient intervention in those with frailty admitted to ICUs with severe COVID-19.
Not applicable.
尽管虚弱与死亡率相关，但其对COVID-19入住重症监护病房（ICU）后的长期生存影响尚不清楚。我们旨在研究COVID-19入住ICU患者的虚弱与长期生存之间的关联。
设计、背景和参与者：这项基于登记的多中心、回顾性队列研究纳入了所有16岁及以上因COVID-19入住ICU后存活出院且记录了临床虚弱量表（CFS）的患者。来自新西兰2020年1月1日至2020年12月31日以及澳大利亚2021年12月31日期间118个ICU的数据报告于澳大利亚和新西兰重症监护学会成人患者数据库。患者被分为“非虚弱”（CFS 1 - 3）、“轻度虚弱”（CFS 4 - 5）和“中度至重度虚弱”（CFS 6 - 8）。
主要结局是长达两年的生存时间，我们使用Cox回归模型进行分析。
最终分析纳入了4028例COVID-19患者。“中度至重度虚弱”患者比非虚弱患者年龄更大（66.6[56.3 - 75.8]岁 vs. 69.9[60.3 - 78.1]岁；p < 0.001）（非虚弱患者中位数[四分位间距]为53.0[40.1 - 64.6]岁），序贯器官衰竭评估得分更高（p < 0.001），与非虚弱或轻度虚弱患者相比，接受机械通气的可能性更小（p < 0.001）。在调整混杂因素后，轻度虚弱患者（调整后风险比：2.31，95%置信区间：1.75 - 3.05）和中度至重度虚弱患者（调整后风险比：2.54，95%置信区间：1.89 - 3.42）的死亡率高于非虚弱患者。
在澳新地区，出院后严重COVID-19患者的虚弱与两年内较短的生存时间独立相关。识别虚弱可为入住ICU的严重COVID-19虚弱患者提供个体化的患者干预。
不适用。
