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Preexisting Clinical Frailty Is Associated With Worse Clinical Outcomes in Patients With Sepsis*
Critical Care Medicine ( IF 8.8 ) Pub Date : 2022-05-01 , DOI: 10.1097/ccm.0000000000005360
Hong Yeul Lee 1 , Jinwoo Lee 1 , Yoon Sun Jung 1 , Woon Yong Kwon 1 , Dong Kyu Oh 1 , Mi Hyeon Park 1 , Chae-Man Lim 1 , Sang-Min Lee 1 ,
Affiliation  

OBJECTIVES: 

Frailty is a multidimensional syndrome or state of increased vulnerability to poor resolution of homoeostasis following a stressor event. Frailty is common in patients with sepsis. Sepsis and frailty are both associated with older age and chronic medical conditions. However, there is limited evidence about the direct association between frailty and sepsis. The aim of this study is to determine the association between preexisting clinical frailty and clinical outcomes in patients with sepsis.

DESIGN: 

A nationwide propensity score–matched cohort study analyzing data prospectively collected between September 2019 and February 2020.

SETTING: 

Nineteen tertiary or university-affiliated hospitals in South Korea.

PATIENTS: 

Adult patients who were diagnosed with sepsis.

INTERVENTIONS: 

None.

MEASUREMENTS AND MAIN RESULTS: 

Frailty status was assessed using the Clinical Frailty Scale. All patients were classified as “frail” (Clinical Frailty Scale score, 5–9) or “nonfrail” (Clinical Frailty Scale score, 1–4). Propensity score matching identified comparable nonfrail patients. The primary outcome was inhospital mortality. Multivariable logistic regression analysis was used to evaluate the association between frailty and inhospital mortality. The propensity score–matched cohort comprised 468 nonfrail patients and 468 frail patients; all covariate imbalances were alleviated. In the matched cohort (mean age, 69 ± 14 yr), 27.2% had septic shock at presentation. Inhospital mortality was 34.2% in the frail group and 26.9% in the nonfrail group (p = 0.019). The adjusted odds ratio for inhospital mortality in the frail group compared with the nonfrail group was 2.00 (95% CI, 1.39–2.89; p < 0.001). Among the patients who survived to discharge, the frail group was less likely to be discharged home compared with the nonfrail group, 64.0% versus 81.3%, respectively (p < 0.001).

CONCLUSIONS: 

In patients with sepsis, preexisting clinical frailty is associated with worse clinical outcomes than that in nonfrail patients, including inhospital mortality and discharge to home.



中文翻译:

先前存在的临床虚弱与脓毒症患者更糟糕的临床结果相关*

目标: 

虚弱是一种多维综合征或在应激事件后体内稳态的解决能力较差的脆弱性增加的状态。虚弱在败血症患者中很常见。脓毒症和虚弱都与老年和慢性疾病有关。然而,关于虚弱与脓毒症之间直接关系的证据有限。本研究的目的是确定脓毒症患者先前存在的临床虚弱与临床结果之间的关联。

设计: 

一项全国性倾向评分匹配队列研究分析了 2019 年 9 月至 2020 年 2 月期间前瞻性收集的数据。

环境: 

韩国有十九家三级或大学附属医院。

患者: 

被诊断患有败血症的成年患者。

干预措施: 

没有任何。

测量和主要结果: 

使用临床衰弱量表评估衰弱状态。所有患者均被分类为“虚弱”(临床虚弱量表评分,5-9)或“非虚弱”(临床虚弱量表评分,1-4)。倾向评分匹配确定了可比的非体弱患者。主要结局是院内死亡率。使用多变量逻辑回归分析来评估虚弱与院内死亡率之间的关联。倾向评分匹配队列由 468 名非体弱患者和 468 名体弱患者组成;所有协变量不平衡都得到缓解。在匹配队列中(平均年龄,69 ± 14 岁),27.2% 就诊时患有感染性休克。虚弱组的院内死亡率为 34.2%,非虚弱组的院内死亡率为 26.9% ( p = 0.019)。与非虚弱组相比,虚弱组院内死亡率的调整后比值比为 2.00(95% CI,1.39–2.89;p < 0.001)。在存活出院的患者中,与非虚弱组相比,虚弱组出院回家的可能性较小,分别为 64.0% 和 81.3% ( p < 0.001)。

结论: 

在脓毒症患者中,与非虚弱患者相比,先前存在的临床虚弱与更差的临床结果相关,包括院内死亡率和出院回家。

更新日期:2022-05-01
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