Frailty predicts 30-day mortality in intensive care patients
Frailty predicts 30-day mortality in intensive care patients
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虚弱预示着重症监护患者 30 天的死亡率
DOI：
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发表时间：
2020
影响因子：
3.6
通讯作者：
A. O. Tibblin
中科院分区：
文献类型：
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作者：
L. De Geer;M. Fredrikson;A. O. Tibblin
背景虚弱是一种多维综合征，其特征在于储备损失和不良后果风险增加。目的研究虚弱对重症监护患者死亡率的影响，并比较其与重症监护结局预测模型的区分能力。设计：前瞻性研究，并对两种预测模型进行比较。单位：三级混合ICU，2017年1月至2018年6月。患者和主要观察指标收集了872例成人ICU患者的病前虚弱（临床虚弱量表; CFS）、疾病严重程度（简化急性生理学评分，第三版; SAPS 3）、治疗程序、护理限制和结局的数据。确定了预测30天内死亡的CFS临界值，并使用未校正和校正分析来评估虚弱与结局的相关性。结果CFS的受试者工作曲线、曲线下面积[0.74（95%置信区间，0.69 ~ 0.79）]与SAPS 3 [0.79（0.75 ~ 0.83），P = 0.53]无显著差异，而两者联合使用可提高辨别能力[曲线下面积= 0.82（0.79 ~ 0.86），CFS + SAPS 3 vs. SAPS 3单独使用，P = 0.02]。 CFS与SAPS 3的相关性为中度（r = 0.4）。 临界值确定为CFS至少5，定义43%（n=375）的患者为虚弱。虚弱患者年龄较大，具有较高的SAPS 3和更多的合并症。在ICU中，虚弱患者的治疗更经常被暂停或撤回，死亡率更高。在对SAPS 3、合并症、治疗限制、年龄和性别进行校正后，虚弱仍然是30天内死亡的强预测因子[风险比2.12（95%置信区间，1.44至3.14），P <0.001]。 结论：病前虚弱在综合ICU患者中普遍存在，是死亡的独立预测因素。我们的研究表明，虚弱可能是一个有价值的补充，在重症监护的结果预测。
Supplemental Digital Content is available in the text BACKGROUND Frailty is a multidimensional syndrome characterised by a loss of reserve and an increased risk of adverse outcomes. OBJECTIVE To study the impact of frailty on mortality in unselected intensive care patients, and to compare its discriminatory ability to an established model for outcome prediction in intensive care. DESIGN A prospective study with a comparison of two prediction models. SETTING A tertiary mixed ICU, from January 2017 to June 2018. PATIENTS AND MAIN OUTCOME MEASURES Data on premorbid frailty (clinical frailty scale; CFS), severity of illness (the simplified acute physiology score, third version; SAPS3), therapeutic procedures, limitations of care and outcome were collected in 872 adult ICU patients. A cut-off level of CFS for predicting death within 30 days was identified and unadjusted and adjusted analyses were used to evaluate the association of frailty to outcome. RESULTS The receiver operating curve, area under the curve of CFS [0.74 (95% confidence interval, 0.69 to 0.79)] did not differ significantly from that of SAPS3 [0.79 (0.75 to 0.83), P = 0.53], whereas combining the two resulted in an improved discriminatory ability [area under the curve = 0.82 (0.79 to 0.86), CFS + SAPS3 vs. SAPS3 alone, P = 0.02]. The correlation of CFS to SAPS3 was moderate (r = 0.4). A cut-off level was identified at CFS at least 5, defining 43% (n=375) of the patients as frail. Frail patients were older with higher SAPS3 and more comorbidities. Treatment in the ICU was more often withheld or withdrawn in frail patients, and mortality was higher. After adjustment for SAPS3, comorbidities, limitations of treatment, age and sex, frailty remained a strong predictor of death within 30 days [hazard ratio 2.12 (95% confidence interval, 1.44 to 3.14), P < 0.001]. CONCLUSION Premorbid frailty was common in general ICU patients and was an independent predictor of death. Our study suggests that frailty could be a valuable addition in outcome prediction in intensive care.
DOI：
10.1016/j.jamcollsurg.2010.01.028
发表时间：
2010-06-01
影响因子：
5.2
作者：
Makary, Martin A.;Segev, Dorry L.;Fried, Linda P.
通讯作者：
Fried, Linda P.