虚弱与 30 天死亡率相关：一项瑞典急诊科的多中心研究。

Frailty is associated with 30-day mortality: a multicentre study of Swedish emergency departments.

机构信息

Emergency Department, Linköping University Hospital, Linkoping, Östergötland, Sweden

Emergency Department, Linköping University Hospital, Linkoping, Östergötland, Sweden.

出版信息

Emerg Med J. 2024 Aug 21;41(9):514-519. doi: 10.1136/emermed-2023-213444.

DOI:10.1136/emermed-2023-213444

PMID:39053972

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11347252/

Abstract

BACKGROUND

Older patients living with frailty have an increased risk for adverse events. The Clinical Frailty Scale (CFS) is a 9-point frailty assessment instrument that has shown promise to identify frail emergency department (ED) patients at increased risk of adverse outcomes. The aim of this study was to investigate the association between CFS scores and 30-day mortality in an ED setting when assessments are made by regular ED staff.

METHOD

This was a prospective multicentre observational study carried out between May and November 2021 at three EDs in Sweden, where frailty via CFS is routinely assessed by ED staff. All patients ≥65 years of age were eligible for inclusion. Mortality at 7, 30 and 90 days, admission rate, ED and hospital length of stay (LOS) were compared between patients living with frailty (CFS≥5) and robust patients. Logistic regression was used to adjust for confounders.

RESULTS

A total of 1840 ED visits of patients aged ≥65 years with CFS assessments done during the study period were analysed, of which 606 (32.9%) were patients living with frailty. Mortality after the index visit was higher in patients living with frailty at 7 days (2.6% vs 0.2%), 30 days (7.9% vs 0.9%) and 90 days (15.5% vs 2.4%). Adjusted ORs for mortality for those with frailty compared with more robust patients were 9.9 (95% CI 2.1 to 46.5) for 7-day, 6.0 (95% CI 3.0 to 12.2) for 30-day and 5.7 (95% CI 3.6 to 9.1) 90-day mortality. Patients living with frailty had higher admission rates, 58% versus 36%, a difference of 22% (95% CI 17% to 26%), longer ED LOS, 5 hours:08 min versus 4 hours:36 min, a difference of 31 min (95% CI 14 to 50), and longer in-hospital LOS, 4.8 days versus 2.7 days, a difference of 2.2 days (95% CI 1.2 to 3.0).

CONCLUSION

Patients living with frailty, had significantly higher mortality and admission rates as well as longer ED and in-hospital LOS compared with robust patients. The results confirm the capability of the CFS to risk stratify short-term mortality in older ED patients.

TRIAL REGISTRATION NUMBER

NCT04877028.

摘要

背景

患有虚弱症的老年患者发生不良事件的风险增加。临床虚弱量表（CFS）是一种 9 分制的虚弱评估工具，已被证明可用于识别急诊科（ED）中处于高风险的虚弱患者，这些患者发生不良结局的风险增加。本研究的目的是在 ED 工作人员进行评估时，研究 CFS 评分与 ED 环境中 30 天死亡率之间的关联。

方法

这是一项前瞻性多中心观察性研究，于 2021 年 5 月至 11 月在瑞典的 3 家 ED 进行，ED 工作人员常规使用 CFS 评估虚弱程度。所有年龄≥65 岁的患者均符合纳入标准。比较虚弱患者（CFS≥5）和健康患者的 7、30 和 90 天死亡率、入院率、ED 和住院时长（LOS）。使用逻辑回归调整混杂因素。

结果

分析了研究期间接受 CFS 评估的≥65 岁 ED 就诊患者的 1840 例，其中 606 例（32.9%）为虚弱患者。与健康患者相比，虚弱患者在就诊后 7 天（2.6%比 0.2%）、30 天（7.9%比 0.9%）和 90 天（15.5%比 2.4%）的死亡率更高。与健康患者相比，虚弱患者的 7 天、30 天和 90 天死亡的调整比值比（OR）分别为 9.9（95%CI 2.1 至 46.5）、6.0（95%CI 3.0 至 12.2）和 5.7（95%CI 3.6 至 9.1）。虚弱患者的入院率较高，为 58%比 36%，差异为 22%（95%CI 17%至 26%），ED LOS 较长，为 5 小时：08 分比 4 小时：36 分，差异为 31 分钟（95%CI 14 至 50），住院 LOS 较长，为 4.8 天比 2.7 天，差异为 2.2 天（95%CI 1.2 至 3.0）。