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虚弱对因 COVID-19 入住重症监护病房后存活出院患者长期生存的影响。

Impact of frailty on long-term survival in patients discharged alive from hospital after an ICU admission with COVID-19.

作者信息

Subramaniam Ashwin, Ling Ryan Ruiyang, Pilcher David

机构信息

Department of Intensive Care, Peninsula Health, Frankston, Victoria, Australia.

Department of Intensive Care, Dandenong Hospital, Monash Health, Dandenong, Victoria, Australia.

出版信息

Crit Care Resusc. 2023 Dec 14;26(1):16-23. doi: 10.1016/j.ccrj.2023.11.001. eCollection 2024 Mar.


DOI:10.1016/j.ccrj.2023.11.001
PMID:38690183
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11056397/
Abstract

OBJECTIVE: 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. DESIGN SETTING AND PARTICIPANTS: 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). MAIN OUTCOME MEASURES: The primary outcome was survival time up to two years, which we analysed using Cox regression models. RESULTS: 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. CONCLUSIONS: 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. CLINICAL TRIAL REGISTRATION: Not applicable.

摘要

目的: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)。 主要观察指标: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。 结果: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。 结论: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。 临床试验注册:不适用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b348/11056397/3e94e68d7bcc/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b348/11056397/c8ebc34e3a8b/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b348/11056397/3e94e68d7bcc/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b348/11056397/c8ebc34e3a8b/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b348/11056397/3e94e68d7bcc/gr2.jpg

相似文献

[1]
Impact of frailty on long-term survival in patients discharged alive from hospital after an ICU admission with COVID-19.

Crit Care Resusc. 2023-12-14

[2]
Comparison of the predictive ability of clinical frailty scale and hospital frailty risk score to determine long-term survival in critically ill patients: a multicentre retrospective cohort study.

Crit Care. 2022-5-3

[3]
Frailty and outcomes from pneumonia in critical illness: a population-based cohort study.

Br J Anaesth. 2020-9-3

[4]
Association between Clinical Frailty Scale score and hospital mortality in adult patients with COVID-19 (COMET): an international, multicentre, retrospective, observational cohort study.

Lancet Healthy Longev. 2021-3

[5]
The impact of body mass index on long-term survival after ICU admission due to COVID-19: A retrospective multicentre study.

Crit Care Resusc. 2023-11-22

[6]
The impact of frailty on survival times up to one year among patients admitted to ICU with in-hospital cardiac arrest.

J Crit Care. 2024-10

[7]
Frailty in very old critically ill patients in Australia and New Zealand: a population-based cohort study.

Med J Aust. 2019-9-5

[8]
Frailty and long-term survival among patients in Australian intensive care units with metastatic cancer (FRAIL-CANCER study): a retrospective registry-based cohort study.

Lancet Healthy Longev. 2023-12

[9]
Comparing the Clinical Frailty Scale and an International Classification of Diseases-10 Modified Frailty Index in Predicting Long-Term Survival in Critically Ill Patients.

Crit Care Explor. 2022-10-13

[10]
Impact of frailty on clinical outcomes in patients with and without COVID-19 pneumonitis admitted to intensive care units in Australia and New Zealand: a retrospective registry data analysis.

Crit Care. 2022-10-3

本文引用的文献

[1]
The Clinical Frailty Scale for mortality prediction of old acutely admitted intensive care patients: a meta-analysis of individual patient-level data.

Ann Intensive Care. 2023-5-3

[2]
Frailty is a stronger predictor of death in younger intensive care patients than in older patients: a prospective observational study.

Ann Intensive Care. 2022-12-31

[3]
Impact of frailty on clinical outcomes in patients with and without COVID-19 pneumonitis admitted to intensive care units in Australia and New Zealand: a retrospective registry data analysis.

Crit Care. 2022-10-3

[4]
Treatment limitations and clinical outcomes in critically ill frail patients with and without COVID-19 pneumonitis.

J Am Geriatr Soc. 2023-1

[5]
Association of Frailty, Organ Support, and Long-Term Survival in Critically Ill Patients With COVID-19.

Crit Care Explor. 2022-5-25

[6]
People in intensive care with COVID-19: demographic and clinical features during the first, second, and third pandemic waves in Australia.

Med J Aust. 2022-10-3

[7]
Frailty in Elderly Patients with Covid-19: A Narrative Review.

Gerontol Geriatr Med. 2022-3-4

[8]
Patient-Centered Outcomes Following COVID-19: Frailty and Disability Transitions in Critical Care Survivors.

Crit Care Med. 2022-6-1

[9]
Characteristics and Outcomes of Patients With Frailty Admitted to ICU With Coronavirus Disease 2019: An Individual Patient Data Meta-Analysis.

Crit Care Explor. 2022-1-18

[10]
Long-term survival of mechanically ventilated patients with severe COVID-19: an observational cohort study.

Ann Intensive Care. 2021-10-2

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