Long-term frailty trajectory in older ICU survivors requiring mechanical ventilation: a prospective cohort study in Norway.

IF 6.9 1区医学 Q1 CRITICAL CARE MEDICINE

Annals of Intensive Care Pub Date : 2026-07-16 eCollection Date: 2026-01-01 DOI:10.1016/j.aicoj.2026.100115

B A Kroken, D Bergum, K S Berg, M Espinasse, O K Fossum, M Hoff, P Klepstad, B Å Sjøbø, R Kvåle, H Flaatten, S K Frisvold

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引用次数: 0

Abstract

Background: While intensive care unit (ICU) capacity remains constrained, the number of older patients receiving resource-demanding ICU treatment continues to rise. Yet, long-term outcomes and post-critical illness frailty trajectories remain poorly characterized. We examined long-term mortality and frailty trajectories, and their associations with clinical characteristics and ICU treatment intensity.

Methods: In this prospective, observational study across five Norwegian hospitals representing all health regions, we included patients aged ≥65 years who required invasive mechanical ventilation for ≥24 h. Frailty was assessed using the Clinical Frailty Scale (CFS) at baseline and at 3 and 12 months, categorized as robust (CFS 1-3), prefrail (CFS 4) and frail (CFS ≥ 5). Multiple regression models were used to examine associations between frailty trajectories and mortality, with baseline frailty, clinical characteristics and potentially modifiable aspects of ICU treatment.

Results: 346 patients were included. Mean age was 74 years (± 6), and 98 % lived at home before admission. The median ICU length of stay was 8 (IQR 9) days. Total mortality was 52 %, with most deaths occurring before hospital discharge. In the survivors, the prevalence of frailty increased from 23 % (79/346) at baseline, to 47 % (81/174) at three months. Between the three- and 12- month follow-up, CFS scores remained unchanged in 71 % (108/153), improved in 19 % (29/153) and deteriorated in 10 % (15/153). By 12 months 86 % (132/153) had returned home, though 32 % (49/153) required home care compared to 10 % pre-admission. Baseline CFS showed the strongest association with 12-month mortality (Risk Ratio 1.46, p < 0.001). Age (Risk Ratio 1.22, p < 0.001) and SOFA score on the first day after intubation (Risk Ratio 1.14, p < 0.01) were also significant predictors, whereas comorbidity was not.

Conclusions: In elderly ICU-patients long-term frailty is deranged, and baseline CFS is closely associated with mortality. However, a small group of patients had a transitory decline in frailty at three months follow-up and then improved. Intervention studies targeting modifiable factors associated with long-term functional decline and mortality are warranted.

Trial registration: ClinicalTrials.gov (NCT06012942).

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需要机械通气的老年ICU幸存者的长期衰弱轨迹：挪威的一项前瞻性队列研究。

背景：虽然重症监护室（ICU）的能力仍然有限，但接受资源密集型ICU治疗的老年患者数量继续增加。然而，长期结果和危重症后的脆弱轨迹仍然缺乏特征。我们研究了长期死亡率和衰弱轨迹，以及它们与临床特征和ICU治疗强度的关系。方法：在这项前瞻性观察性研究中，我们纳入了年龄≥65岁、需要有创机械通气≥24小时的患者。在基线、3个月和12个月时，使用临床虚弱量表（CFS）评估虚弱程度，分为强壮（CFS 1-3）、虚弱（CFS 4）和虚弱（CFS≥5）。使用多元回归模型来检查虚弱轨迹与死亡率之间的关系，以及基线虚弱，临床特征和ICU治疗的潜在可修改方面。结果：共纳入346例患者。平均年龄74岁（±6岁），98%患者入院前住在家中。ICU住院时间中位数为8 （IQR 9）天。总死亡率为52%，大多数死亡发生在出院前。在幸存者中，虚弱的患病率从基线时的23%（79/346）增加到三个月时的47%（81/174）。在3个月和12个月的随访期间，CFS评分保持不变的占71%(108/153)，改善的占19%(29/153)，恶化的占10%（15/153）。到12个月时，86%（132/153）已返回家中，尽管32%（49/153）需要家庭护理，而入院前这一比例为10%。基线CFS与12个月死亡率的相关性最强（风险比1.46,p 0.001）。年龄（危险比1.22,p 0.001）和插管后第一天SOFA评分（危险比1.14,p 0.01）也是显著的预测因素，而合并症无显著影响。结论：老年重症监护病房患者的长期虚弱是紊乱的，基线CFS与死亡率密切相关。然而，一小部分患者在三个月的随访中出现了短暂的虚弱下降，然后有所改善。针对与长期功能衰退和死亡率相关的可改变因素的干预研究是有必要的。试验注册：ClinicalTrials.gov （NCT06012942）。

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来源期刊

Annals of Intensive Care CRITICAL CARE MEDICINE-

CiteScore

14.20

自引率

3.70%

发文量

107

审稿时长

13 weeks

期刊介绍： Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.