Ashwin Subramaniam MBBS MMed FRACP FCICM PhD , Ryan Ruiyang Ling Dr MBBS , David Pilcher MBBS MRCP(UK) FRACP FCICM
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Data from 118 ICUs between 01/01/2020 through 31/12/2020 in New Zealand and 31/12/2021 in Australia were reported in the Australian and New Zealand Intensive Care Society Adult Patient Database. The patients were categorised as ‘not frail’ (CFS 1-3), ‘mildly frail’ (CFS 4-5) and ‘moderately-to-severely frail’ (CFS 6-8).</p></div><div><h3>Main Outcome Measures</h3><p>The primary outcome was survival time up to two years, which we analysed using Cox regression models.</p></div><div><h3>Results</h3><p>We included 4028 patients with COVID-19 in the final analysis. ‘Moderately-to-severely frail’ patients were older (66.6 [56.3–75.8] vs. 69.9 [60.3–78.1]; p < 0.001) than those without frailty (median [interquartile range] 53.0 [40.1–64.6]), had higher sequential organ failure assessment scores (p < 0.001), and less likely to receive mechanical ventilation (p < 0.001) than patients without frailty or mild frailty. After adjusting for confounders, patients with mild frailty (adjusted hazards ratio: 2.31, 95%-CI: 1.75–3.05) and moderate-to-severe frailty (adjusted hazards ratio: 2.54, 95%-CI: 1.89–3.42) had higher mortality rates than those without frailty.</p></div><div><h3>Conclusions</h3><p>Frailty was independently associated with shorter survival times to two years in patients with severe COVID-19 in ANZ following hospital discharge. Recognising frailty provides individualised patient intervention in those with frailty admitted to ICUs with severe COVID-19.</p></div><div><h3>Clinical trial registration</h3><p>Not applicable.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 1","pages":"Pages 16-23"},"PeriodicalIF":1.4000,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S144127722302224X/pdfft?md5=623a0c26eafbdc32cf648670cb8341a7&pid=1-s2.0-S144127722302224X-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Impact of frailty on long-term survival in patients discharged alive from hospital after an ICU admission with COVID-19\",\"authors\":\"Ashwin Subramaniam MBBS MMed FRACP FCICM PhD , Ryan Ruiyang Ling Dr MBBS , David Pilcher MBBS MRCP(UK) FRACP FCICM\",\"doi\":\"10.1016/j.ccrj.2023.11.001\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3><strong>Objective</strong></h3><p>Though frailty is associated with mortality, its impact on long-term survival after an ICU admission with COVID-19 is unclear. We aimed to investigate the association between frailty and long-term survival in patients after an ICU admission with COVID-19.</p></div><div><h3><strong>Design, Setting and Participants</strong></h3><p>This registry-based multicentre, retrospective, cohort study included all patients ≥16 years discharged alive from the hospital following an ICU admission with COVID-19 and documented clinical frailty scale (CFS). Data from 118 ICUs between 01/01/2020 through 31/12/2020 in New Zealand and 31/12/2021 in Australia were reported in the Australian and New Zealand Intensive Care Society Adult Patient Database. 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引用次数: 0
摘要
目的虽然虚弱与死亡率有关，但其对使用 COVID-19 入住 ICU 后长期生存的影响尚不清楚。这项基于登记的多中心、回顾性、队列研究纳入了所有因 COVID-19 而入住 ICU 并有临床虚弱量表（CFS）记录的≥16 岁出院的患者。澳大利亚和新西兰重症监护协会成人患者数据库（Australian and New Zealand Intensive Care Society Adult Patient Database）报告了新西兰118个重症监护病房在2020年1月1日至2020年12月31日期间以及澳大利亚在2021年12月31日期间的数据。患者被分为 "不虚弱"（CFS 1-3）、"轻度虚弱"（CFS 4-5）和 "中度至重度虚弱"（CFS 6-8）。中度至重度虚弱 "患者的年龄（66.6 [56.3-75.8] vs. 69.9 [60.3-78.1]; p <0.001）高于无虚弱患者（中位数 [四分位间范围] 53.0 [40.1-64.6]），器官功能衰竭顺序评估评分更高（p <0.001），接受机械通气的可能性也低于无虚弱或轻度虚弱患者（p <0.001）。在对混杂因素进行调整后，轻度虚弱（调整后危险比：2.31，95%-CI：1.75-3.05）和中重度虚弱（调整后危险比：2.54，95%-CI：1.89-3.42）患者的死亡率高于无虚弱患者。识别虚弱程度可为入住重症监护病房的重症 COVID-19 患者提供个体化干预。
Impact of frailty on long-term survival in patients discharged alive from hospital after an ICU admission with COVID-19
Objective
Though frailty is associated with mortality, its impact on long-term survival after an ICU admission with COVID-19 is unclear. We aimed to investigate the association between frailty and long-term survival in patients after an ICU admission with COVID-19.
Design, Setting and Participants
This registry-based multicentre, retrospective, cohort study included all patients ≥16 years discharged alive from the hospital following an ICU admission with COVID-19 and documented clinical frailty scale (CFS). Data from 118 ICUs between 01/01/2020 through 31/12/2020 in New Zealand and 31/12/2021 in Australia were reported in the Australian and New Zealand Intensive Care Society Adult Patient Database. The patients were categorised as ‘not frail’ (CFS 1-3), ‘mildly frail’ (CFS 4-5) and ‘moderately-to-severely frail’ (CFS 6-8).
Main Outcome Measures
The primary outcome was survival time up to two years, which we analysed using Cox regression models.
Results
We included 4028 patients with COVID-19 in the final analysis. ‘Moderately-to-severely frail’ patients were older (66.6 [56.3–75.8] vs. 69.9 [60.3–78.1]; p < 0.001) than those without frailty (median [interquartile range] 53.0 [40.1–64.6]), had higher sequential organ failure assessment scores (p < 0.001), and less likely to receive mechanical ventilation (p < 0.001) than patients without frailty or mild frailty. After adjusting for confounders, patients with mild frailty (adjusted hazards ratio: 2.31, 95%-CI: 1.75–3.05) and moderate-to-severe frailty (adjusted hazards ratio: 2.54, 95%-CI: 1.89–3.42) had higher mortality rates than those without frailty.
Conclusions
Frailty was independently associated with shorter survival times to two years in patients with severe COVID-19 in ANZ following hospital discharge. Recognising frailty provides individualised patient intervention in those with frailty admitted to ICUs with severe COVID-19.
期刊介绍：
ritical Care and Resuscitation (CC&R) is the official scientific journal of the College of Intensive Care Medicine (CICM). The Journal is a quarterly publication (ISSN 1441-2772) with original articles of scientific and clinical interest in the specialities of Critical Care, Intensive Care, Anaesthesia, Emergency Medicine and related disciplines.
The Journal is received by all Fellows and trainees, along with an increasing number of subscribers from around the world.
The CC&R Journal currently has an impact factor of 3.3, placing it in 8th position in world critical care journals and in first position in the world outside the USA and Europe.
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