The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (≥ 80 years)
The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (≥ 80 years)
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DOI：
10.1007/s00134-017-4940-8
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发表时间：
2017-12-01
影响因子：
38.9
通讯作者：
Guidet, Bertrand
中科院分区：
文献类型：
--
作者：
Flaatten, Hans;De lange, Dylan W.;Guidet, Bertrand
高龄重症患者是ICU中迅速扩大的群体。对于此类患者，经常讨论入院指征、分诊标准和护理水平。然而，这一组的大多数相关结局研究经常发现死亡率增加，幸存者的生活质量降低。主要目的是研究虚弱与其他变量相比对高龄ICU人群短期结局的影响。欧洲重症监护医学会于2016年10月至2017年5月开展了一项跨国前瞻性队列研究，随访30天。共有来自21个欧洲国家的311个ICU参与。ICU包括在3个月入选期内入住ICU的首批连续20例高龄（80岁）患者。除护理限制外，还登记了虚弱、SOFA评分和治疗程序。对于虚弱的测量，在ICU入院时使用临床虚弱量表。最终分析共纳入5021例患者，中位年龄84岁（IQR 81-86岁），其中2404例（47.9%）为女性。4215例（83.9%）患者的入院被归类为急性。总体ICU和30天死亡率分别为22.1%和32.6%。在ICU住院期间，23.8%的患者未接受特定的ICU程序：通气、血管活性药物或肾脏替代治疗。在43.1%的患者中发现虚弱（数值5），虚弱与非虚弱患者的30天生存率（HR 1.54; 95%CI 1.38-1.73）独立相关。在入住ICU的高龄患者（80岁）中，临床虚弱量表的连续分级与短期生存率呈负相关。该量表缺失数据的数量非常少。这些结果支持将虚弱添加到该患者的临床评估中group.ClinicalTrials.gov（ID：NCT 03134807）。
Very old critical ill patients are a rapid expanding group in the ICU. Indications for admission, triage criteria and level of care are frequently discussed for such patients. However, most relevant outcome studies in this group frequently find an increased mortality and a reduced quality of life in survivors. The main objective was to study the impact of frailty compared with other variables with regards to short-term outcome in the very old ICU population.A transnational prospective cohort study from October 2016 to May 2017 with 30 days follow-up was set up by the European Society of Intensive Care Medicine. In total 311 ICUs from 21 European countries participated. The ICUs included the first consecutive 20 very old (80 years) patients admitted to the ICU within a 3-month inclusion period. Frailty, SOFA score and therapeutic procedures were registered, in addition to limitations of care. For measurement of frailty the Clinical Frailty Scale was used at ICU admission. The main outcomes were ICU and 30-day mortality and survival at 30 days.A total of 5021 patients with a median age of 84 years (IQR 81-86 years) were included in the final analysis, 2404 (47.9%) were women. Admission was classified as acute in 4215 (83.9%) of the patients. Overall ICU and 30-day mortality rates were 22.1% and 32.6%. During ICU stay 23.8% of the patients did not receive specific ICU procedures: ventilation, vasoactive drugs or renal replacement therapy. Frailty (values 5) was found in 43.1% and was independently related to 30-day survival (HR 1.54; 95% CI 1.38-1.73) for frail versus non-frail.Among very old patients (80 years) admitted to the ICU, the consecutive classes in Clinical Frailty Scale were inversely associated with short-term survival. The scale had a very low number of missing data. These findings provide support to add frailty to the clinical assessment in this patient group.ClinicalTrials.gov (ID: NCT03134807).