期刊
CHEST
卷 153, 期 6, 页码 1378-1386出版社
ELSEVIER
DOI: 10.1016/j.chest.2018.03.007
关键词
aging; critical care; disability; epidemiology
资金
- Paul B. Beeson Emerging Leaders Career Development Award in Aging from the National Institute on Aging (NIA) [K76AG057023]
- Francis Family Foundation
- GEMSSTAR [Grants for Early Medical and Surgical Subspecialists' Transition to Aging Research] award from the NIA [R03AG050874]
- Pepper Scholar award from the Yale Claude D. Pepper Older Americans Independence Center [NIH/NIA P30AG021342, T32AG019134]
- T. Franklin Williams Scholars Program award
- Atlantic Philanthropies, Inc.
- John A. Hartford Foundation
- Alliance for Academic Internal Medicine-Association of Specialty Professors
- American Thoracic Society Foundation
- NIA [R01AG017560, K07AG043587]
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.
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