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重症监护病房出院时的临床衰弱量表可预测再次入住重症监护病房及重症监护病房后的死亡率:一项回顾性单中心研究。

Clinical frailty scale at ICU discharge predicts ICU readmission and post-ICU mortality: A retrospective single-center study.

作者信息

Lee Heayon, Lee Bora, Youn Hyun Joo, Cho Choong Hee, Lee Jin Hee, Kim Sei Won

机构信息

Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Department of Nursing, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

出版信息

Medicine (Baltimore). 2025 Jun 20;104(25):e42955. doi: 10.1097/MD.0000000000042955.

Abstract

Despite successful discharge from the intensive care unit (ICU), a substantial number of patients remain at risk of ICU readmission or death. Identifying high-risk individuals at the time of ICU discharge is essential for planning post-ICU care. This study aimed to assess the Clinical Frailty Scale (CFS) at ICU discharge as a screening tool for predicting ICU readmission and post-ICU mortality, and to compare its predictive performance with other commonly used scoring systems. We conducted a retrospective single-center study including adult patients (≥20 years) discharged from all ICUs to general wards. Patients discharged for non-recovery purposes were excluded. Within 24 hours of ICU discharge, clinical scores: Acute Physiology and Chronic Health Evaluation II, Modified Early Warning Score, National Early Warning Score, Sequential Organ Failure Assessment (SOFA), and CFS, were assessed. The primary outcome was a composite of ICU readmission or all-cause mortality after ICU discharge. Univariate and multivariate logistic regression analyses were performed to identify independent predictors. A total of 648 patients were included. ICU readmission or post-ICU mortality occurred in 6.5% of patients. Compared to others, these patients had significantly higher Charlson Comorbidity Index scores (P = .002), more frequent delirium (P < .001), and received more intensive interventions such as mechanical ventilation or high-flow oxygen (P < .001), vasopressors (P < .001), and hemodialysis (P < .001). In multivariate analysis, both SOFA score (P < .001) and CFS score (P = .002) remained independent predictors of adverse outcomes. CFS demonstrated the highest discriminative ability (area under the curve, 0.788) compared to SOFA (0.722), Acute Physiology and Chronic Health Evaluation II (0.718), National Early Warning Score (0.725), and Modified Early Warning Score (0.695). The CFS assessed at ICU discharge is a simple, accessible, and effective tool for predicting ICU readmission and post-ICU mortality. Compared to other commonly used scores, CFS demonstrated favorable predictive performance and may serve as a practical option for routine discharge planning and risk stratification in post-ICU care.

摘要

尽管从重症监护病房(ICU)成功出院,但仍有相当数量的患者面临再次入住ICU或死亡的风险。在ICU出院时识别高危个体对于规划ICU后的护理至关重要。本研究旨在评估ICU出院时的临床衰弱量表(CFS)作为预测ICU再入院和ICU后死亡率的筛查工具,并将其预测性能与其他常用评分系统进行比较。我们进行了一项回顾性单中心研究,纳入了从所有ICU出院至普通病房的成年患者(≥20岁)。因未康复目的出院的患者被排除。在ICU出院后24小时内,评估临床评分:急性生理与慢性健康状况评价II、改良早期预警评分、国家早期预警评分、序贯器官衰竭评估(SOFA)和CFS。主要结局是ICU再入院或ICU出院后的全因死亡率。进行单因素和多因素逻辑回归分析以确定独立预测因素。共纳入648例患者。6.

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