Moving Forward: Frailty and Adverse Sepsis Outcomes.
Moving Forward: Frailty and Adverse Sepsis Outcomes.
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前进：虚弱和败血症的不良后果。
DOI：
10.1097/ccm.0000000000005377
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发表时间：
2022
影响因子：
8.8
通讯作者：
Barbash,IanJ
中科院分区：
文献类型：
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作者：
Barbash,IanJ
重症监护医学www. ccmjournal。org 881和幸存者中的医疗保健利用率增加（7）。然而，这项研究仅包括两家医院收治的65岁以上的患者，可能影响其普遍性。也许最重要的是，因为所有关于虚弱作为脓毒症危险因素的研究本质上都是观察性的，所以仍然存在未观察到的混淆的威胁-特别是如果关于护理或出院处置的积极性的决定受到临床医生对患者是否虚弱的印象的影响。Lee等人（8）通过分析韩国国家脓毒症登记研究中既存虚弱与脓毒症结局之间的相关性，以既往文献为基础。值得注意的是，研究人群包括所有年龄段的成年人，而不是仅限于老年人。作者使用临床虚弱量表（CFS）来定义虚弱，这是一种经过充分验证的虚弱指标。然后，他们使用倾向评分匹配来生成一个由468对匹配的虚弱和非虚弱的脓毒症成年人组成的队列。主要发现是，在匹配样本中，体弱患者的住院死亡率高于非体弱患者（死亡率分别为34.2%和26.9%）。在对倾向评分和其他潜在相关混杂因素进行多变量风险调整后，这种相关性仍然很强。进一步的分析显示了“剂量-反应”关系，CFS上每增加一点，住院死亡风险增加1.16倍。当作者对整个不匹配队列而不仅仅是倾向匹配队列使用logistic回归时，28天死亡率的次要结局结果是一致的，并且相似。作者适当地得出结论，他们的分析进一步支持虚弱和脓毒症不良结局之间的因果关系。这项研究有几个重要的优势。到目前为止，最重要的是，该队列来自一个专门围绕败血症研究设计的大型韩国全国性登记中心。因此，患者数量众多，包括许多体弱患者和65岁以下的患者。研究的规模允许作者使用稳健的倾向评分匹配分析，同时在分析中保留合理数量的患者。事实上，该队列包括来自19家医院的患者，这也减少了医院特定的治疗决策偏见导致体弱多病患者不同结果的可能性。
Critical Care Medicine www. ccmjournal. org 881 and increased healthcare utilization among survivors (7). However, this study included only patients over the age of 65 admitted to just two hospitals, potentially affecting its generalizability. Perhaps most importantly, because all studies on frailty as a risk factor for sepsis are by nature observational, there remains a threat from unobserved confounding—particularly if decisions about aggressiveness of care or discharge disposition are influenced by clinicians’ impressions of whether a patient is frail.In this issue of Critical Care Medicine, Lee et al (8) build upon the prior literature by analyzing the association between preexisting frailty and sepsis outcomes from a national sepsis registry in South Korea. Notably, the study population included adults of all ages, rather than restricting inclusion to older adults. The authors defined frailty using the Clinical Frailty Scale (CFS), a well-validated frailty measure. They then used propensity score matching to generate a cohort of 468 matched pairs of frail and nonfrail adults admitted with sepsis. The primary finding was that hospital mortality was higher in frail than in nonfrail patients in the matched sample (mortality rates of 34.2% vs 26.9%). This association remained robust after multivariable risk adjustment for both the propensity score and other potentially relevant confounders. Further analyses demonstrated a “dose-response” relationship, in which each additional point on the CFS was associated with a 1.16-increased fold risk for inhospital mortality. The findings were consistent for the secondary outcome of 28-day mortality and similar when the authors used logistic regression on the entire unmatched cohort rather than just the propensity-matched cohort. The authors appropriately concluded that their analyses provide further support of a causal link between frailty and adverse sepsis outcomes. This study has several important strengths. By far, the most important is that the cohort came from a large, South Korean nationwide registry designed specifically around the study of sepsis. As a result, there were a large number of patients, including many patients with frailty and patients under the age of 65. The size of the study permitted the authors to use a robust propensity score matching analysis while preserving a reasonable number of patients in the analysis. The fact that the cohort included patients from 19 hospitals also reduces the chances that hospital-specific biases in treatment decisions drove differential outcomes in frail