Saxena Sulekha, Gupta Priyamvada, Panwar Puneet, Jain Ashish, Jain Srishti S, Jain Rohit, Gupta Divyansh, Meena Munesh, Acharya Hemraj, Jain Ravi
Department of Critical Care Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India.
Department of Anesthesiology Critical Care and Pain Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India.
Indian J Crit Care Med. 2025 Apr;29(4):320-326. doi: 10.5005/jp-journals-10071-24949.
Advanced age is a known marker of vulnerability, but frailty is an independent predictor of poor outcomes in critically ill patients. The clinical frailty score (CFS) facilitates rapid assessment, aiding prognostication, care improvement, and resource allocation, particularly in resource-limited intensive care units (ICUs).
A prospective observational cohort study was conducted from April to September 2023 at a tertiary care ICU. The study included 166 patients aged ≥50 years with ICU stays longer than 48 hours, excluding those with contraindications for care escalation. Data were collected on demographics, Clinical parameters, and scoring systems including acute physiological and chronic health evaluation II (APACHE-II), sequential organ failure assessment (SOFA), Charlson comorbidity index (CCI), and CFS. Predictive analyses were performed using receiver operating curve (ROC) curves, cut-offs, and logistic regression.
The median age of patients was 65 years, with an APACHE-II score of 18 and a CFS of 4. In-hospital mortality was 46.4%. The CFS outperformed other scoring systems in predicting both in-hospital mortality [Area under the receiver operating characteristic curve (AUC-ROC) 0.73] and net negative outcomes (AUC ROC 0.75). Frailty (CFS ≥6) was present in 39.75% of patients, with each unit increase in CFS associated with a 41.8% higher odds of mortality and a 50.7% higher odds of net negative outcomes. The optimal CFS cut-offs were 4 for 80% sensitivity and 6 for 80% specificity.
The CFS is a practical and reliable tool for predicting ICU outcomes, outperforming traditional scoring systems. It supports improved decision-making and resource allocation. Further multicenter studies are necessary to validate its broader use in critical care practice.
Saxena S, Gupta P, Panwar P, Jain A, Jain SS, Jain R, . Impact of the Clinical Frailty Score on Outcomes of Critically Ill Patients in a Tertiary Care ICU. Indian J Crit Care Med 2025;29(4):320-326.
高龄是已知的脆弱标志，但衰弱是危重症患者不良预后的独立预测因素。临床衰弱评分（CFS）有助于快速评估，辅助预后判断、改善护理及资源分配，尤其在资源有限的重症监护病房（ICU）。
2023年4月至9月在一家三级护理ICU进行了一项前瞻性观察队列研究。该研究纳入了166例年龄≥50岁、ICU住院时间超过48小时的患者，排除了存在护理升级禁忌证的患者。收集了人口统计学、临床参数及评分系统的数据，包括急性生理与慢性健康状况评价II（APACHE-II）、序贯器官衰竭评估（SOFA）、查尔森合并症指数（CCI）和CFS。使用受试者工作特征曲线（ROC）、截断值和逻辑回归进行预测分析。
患者的中位年龄为65岁，APACHE-II评分为18分，CFS为4分。院内死亡率为46.4%。CFS在预测院内死亡率[受试者工作特征曲线下面积（AUC-ROC）为0.73]和净不良结局（AUC ROC为0.75）方面优于其他评分系统。39.75%的患者存在衰弱（CFS≥6），CFS每增加一个单位，死亡几率高41.8%，净不良结局几率高50.7%。CFS的最佳截断值为80%灵敏度时为4分，80%特异度时为6分。
CFS是预测ICU结局的实用且可靠工具，优于传统评分系统。它有助于改善决策和资源分配。需要进一步开展多中心研究以验证其在危重症护理实践中的更广泛应用。
Saxena S, Gupta P, Panwar P, Jain A, Jain SS, Jain R, . 临床衰弱评分对三级护理ICU危重症患者结局的影响。《印度危重症医学杂志》2025；29(4):320 - 326。
