预测波兰重症监护病房≥80 岁患者结局的因素- VIP2 前瞻性观察研究的事后分析。
Predictors of outcomes of patients ≥ 80 years old admitted to intensive care units in Poland - a post-hoc analysis of the VIP2 prospective observational study.
机构信息
Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland.
Department of Anaesthesiology, Intensive Therapy and Pain Treatment, Poznan University of Medical Sciences, Poznan, Poland.
出版信息
Anaesthesiol Intensive Ther. 2024;56(1):61-69. doi: 10.5114/ait.2024.138192.
INTRODUCTION
Elderly patients pose a significant challenge to intensive care unit (ICU) clinicians. In this study we attempted to characterise the population of patients over 80 years old admitted to ICUs in Poland and identify associations between clinical features and short-term outcomes.
MATERIAL AND METHODS
The study is a post-hoc analysis of the Polish cohort of the VIP2 European prospective observational study enrolling patients > 80 years old admitted to ICUs over a 6-month period. Data including clinical features, clinical frailty scale (CFS), geriatric scales, interventions within the ICU, and outcomes (30-day and ICU mortality and length of stay) were gathered. Univariate analyses comparing frail (CFS > 4) to non-frail patients and survivors to non-survivors were performed. Multivariable models with CFS, activities of daily living score (ADL), and the cognitive decline questionnaire IQCODE as predictors and ICU or 30-day mortality as outcomes were formed.
RESULTS
A total of 371 patients from 27 ICUs were enrolled. Frail patients had significantly higher ICU (58% vs. 44.45%, P = 0.03) and 30-day (65.61% vs. 54.14%, P = 0.01) mortality compared to non-frail counterparts. The survivors had significantly lower SOFA score, CFS, ADL, and IQCODE than non-survivors. In multivariable analysis CFS (OR 1.15, 95% CI: 1.00-1.34) and SOFA score (OR 1.29, 95% CI: 1.19-1.41) were identified as significant predictors for ICU mortality; however, CFS was not a predictor for 30-day mortality ( P = 0.07). No statistical significance was found for ADL, IQCODE, polypharmacy, or comorbidities.
CONCLUSIONS
We found a positive correlation between CFS and ICU mortality, which might point to the value of assessing the score for every patient admitted to the ICU. The older Polish ICU patients were characterised by higher mortality compared to the other European countries.
简介
老年患者对重症监护病房（ICU）的临床医生来说是一个重大挑战。在这项研究中，我们试图描述在波兰 ICU 住院的 80 岁以上患者的人群特征，并确定临床特征与短期结局之间的关联。
材料和方法
这是一项对 VIP2 欧洲前瞻性观察研究波兰队列的事后分析，该研究纳入了在 6 个月期间入住 ICU 的年龄大于 80 岁的患者。收集了包括临床特征、临床虚弱量表（CFS）、老年量表、ICU 内干预措施以及结局（30 天和 ICU 死亡率和住院时间）在内的数据。对虚弱（CFS＞4）和非虚弱患者以及幸存者与非幸存者进行了单变量分析。使用 CFS、日常生活活动评分（ADL）和认知衰退问卷 IQCODE 作为预测因子，ICU 或 30 天死亡率作为结局，建立了多变量模型。
结果
共纳入了来自 27 个 ICU 的 371 名患者。与非虚弱患者相比，虚弱患者的 ICU（58% vs. 44.45%，P=0.03）和 30 天（65.61% vs. 54.14%，P=0.01）死亡率显著更高。幸存者的 SOFA 评分、CFS、ADL 和 IQCODE 显著低于非幸存者。在多变量分析中，CFS（OR 1.15，95%CI：1.00-1.34）和 SOFA 评分（OR 1.29，95%CI：1.19-1.41）被确定为 ICU 死亡率的显著预测因子；然而，CFS 不是 30 天死亡率的预测因子（P=0.07）。ADL、IQCODE、多药治疗或合并症与结果之间无统计学意义。
结论
我们发现 CFS 与 ICU 死亡率之间存在正相关，这可能表明评估每个 ICU 患者的评分具有一定的价值。与其他欧洲国家相比，波兰 ICU 老年患者的死亡率更高。
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