在 ICU 中因院内心搏骤停而入院的患者中，虚弱对生存时间长达一年的影响。

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

机构信息

Intensive Care Medicine, Eastern Health, Victoria, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Victoria, Australia.

Intensive Care Medicine, Peninsula Health, Victoria, Australia; Intensive Care Medicine, Calvary Hospital Health, Canberra, Australia.

出版信息

J Crit Care. 2024 Oct;83:154842. doi: 10.1016/j.jcrc.2024.154842. Epub 2024 Jun 11.

DOI:10.1016/j.jcrc.2024.154842

PMID:38865757

Abstract

BACKGROUND

In-hospital cardiac arrest (IHCA) is a serious medical emergency. When IHCA occurs in patients with frailty, short-term survival is poor. However, the impact of frailty on long-term survival is unknown.

METHODS

We performed a retrospective multicentre study of all critically ill adult (age ≥ 16 years) patients admitted to Australian intensive care units (ICU) between 1st January 2018 to 31st March 2022. We included all patients who had an IHCA within the 24 h before ICU admission with a documented Clinical Frail Scale (CFS). The primary outcome was median survival up to one year following ICU admission. The effect of frailty on one-year survival was assessed using a Cox proportional hazards model, adjusting for age, sex, comorbidities, sequential organ failure assessment (SOFA) score, and hospital type.

RESULTS

We examined 3769 patients, of whom 30.8% (n = 1160) were frail (CFS ≥ 5). The median survival was significantly shorter for patients with frailty (median [IQR] days 19 [1-365] vs 302 [9-365]; p < 0.001). The overall one-year mortality was worse for the patients with frailty when compared to the non-frail group (64.8% [95%CI 61.9-67.5] vs 36.4% [95%CI 34.5-38.3], p < 0.001). Each unit increment in the CFS was associated with 22% worse survival outcome (adjusted Hazard ratio = 1.22, 95%-CI 1.19-1.26), after adjustment for confounders. The survival trend was similar among patients who survived the hospitalization.

CONCLUSION

In this retrospective multicentre study, frailty was associated with poorer one-year survival in patients admitted to Australian ICUs following an IHCA.

摘要

背景

院内心搏骤停（IHCA）是一种严重的医疗紧急情况。当 IHCA 发生在虚弱的患者中时，短期生存率较差。然而，虚弱对长期生存率的影响尚不清楚。

方法

我们对 2018 年 1 月 1 日至 2022 年 3 月 31 日期间在澳大利亚重症监护病房（ICU）入住的所有危重症成年（年龄≥16 岁）患者进行了回顾性多中心研究。我们纳入了所有在 ICU 入院前 24 小时内发生 IHCA 且有记录的临床虚弱量表（CFS）的患者。主要结局是 ICU 入院后一年的中位生存时间。使用 Cox 比例风险模型评估虚弱对一年生存率的影响，调整因素包括年龄、性别、合并症、序贯器官衰竭评估（SOFA）评分和医院类型。

结果

我们共检查了 3769 例患者，其中 30.8%（n=1160）为虚弱（CFS≥5）。虚弱患者的中位生存时间明显更短（中位数[IQR]天 19[1-365]比 302[9-365]；p<0.001）。与非虚弱组相比，虚弱患者的总体一年死亡率更差（64.8%[95%CI 61.9-67.5]比 36.4%[95%CI 34.5-38.3]，p<0.001）。在调整混杂因素后，CFS 每增加一个单位，生存结果就会恶化 22%（调整后的危险比=1.22，95%CI 1.19-1.26）。在住院期间存活的患者中，生存趋势相似。