The Association of Frailty With Post-ICU Disability, Nursing Home Admission, and Mortality A Longitudinal Study
The Association of Frailty With Post-ICU Disability, Nursing Home Admission, and Mortality A Longitudinal Study
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DOI：
10.1016/j.chest.2018.03.007
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发表时间：
2018-06-01
期刊：
影响因子：
9.6
通讯作者：
Gill, Thomas M.
中科院分区：
文献类型：
--
作者：
Ferrante, Lauren E.;Pisani, Margaret A.;Gill, Thomas M.
背景技术背景：虚弱是老年人脆弱性的一个强有力的指标，但其与ICU结局的相关性尚未进行前瞻性评估（即，在ICU入院前获得客观评估）。我们的目的是前瞻性地评估虚弱和ICU后残疾、入住疗养院事件和死亡之间的关系。方法：父母队列包括754名年龄≥ 70岁的成年人，他们每月评估13项功能活动的残疾，每18个月评估一次虚弱（1998-2014）。使用Fried指数评估虚弱程度，其中虚弱、预虚弱和非虚弱分别定义为至少三个、一个或两个和零个标准（五个标准）。分析样本包括391名ICU住院患者。结果：平均年龄为84.0岁。在391例住院患者中，分别有213例（54.5%）和140例（35.8%）存在虚弱和虚弱前期。相对于非虚弱，虚弱与危重病后6个月内残疾增加41%相关（校正风险比，1.41; 95%CI，1.12-1.78）;虚弱前期残疾增加28%（校正风险比，1.28; 95%CI，1.01-1.63）。虚弱（优势比，3.52; 95%CI，1.23-10.08），但不虚弱（优势比，2.01; 95%CI，0.77-5.24），与增加疗养院入院。在6个月的随访中，虚弱计数每增加一个点（范围，0-5）与死亡可能性增加一倍相关（风险比，2.00; 95%CI，1.33-3.00）。结论：ICU前虚弱状态与ICU后残疾和ICU幸存者新的疗养院入院率增加以及所有入院者死亡率增加相关。ICU前虚弱状态可以提供有关危重疾病后结局的预后信息。
BACKGROUND: Frailty is a strong indicator of vulnerability among older persons, but its association with ICU outcomes has not been evaluated prospectively (ie, with objectivemeasurements obtained prior to ICU admission). Our objective was to prospectively evaluate the relationship between frailty and post-ICU disability, incident nursing home admission, and death.METHODS: The parent cohort included 754 adults aged >= 70 years, who were evaluated monthly for disability in 13 functional activities and every 18 months for frailty (1998-2014). Frailty was assessed using the Fried index, where frailty, prefrailty, and nonfrailty were defined, respectively, as at least three, one or two, and zero criteria (of five). The analytic sample included 391 ICU admissions.RESULTS: The mean age was 84.0 years. Frailty and prefrailty were present prior to 213 (54.5%) and 140 (35.8%) of the 391 admissions, respectively. Relative to nonfrailty, frailty was associated with 41% greater disability over the 6 months following a critical illness (adjusted risk ratio, 1.41; 95% CI, 1.12-1.78); prefrailty conferred 28% greater disability (adjusted risk ratio, 1.28; 95% CI, 1.01-1.63). Frailty (odds ratio, 3.52; 95% CI, 1.23-10.08), but not prefrailty (odds ratio, 2.01; 95% CI, 0.77-5.24), was associated with increased nursing home admission. Each one-point increase in frailty count (range, 0-5) was associated with double the likelihood of death (hazard ratio, 2.00; 95% CI, 1.33-3.00) through 6 months of follow-up.CONCLUSIONS: Pre-ICU frailty status was associated with increased post-ICU disability and new nursing home admission among ICU survivors, and death among all admissions. Pre-ICU frailty status may provide prognostic information about outcomes after a critical illness.