Frailty, Outcomes, Recovery and Care Steps of Critically Ill Patients (FORECAST): a prospective, multi-centre, cohort study,Intensive Care Medicine

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Frailty, Outcomes, Recovery and Care Steps of Critically Ill Patients (FORECAST): a prospective, multi-centre, cohort study
Intensive Care Medicine ( IF 27.1 ) Pub Date : 2024-05-15 , DOI: 10.1007/s00134-024-07404-9
John Muscedere ₁ , Sean M Bagshaw ₂ , Michelle Kho ₃ , Sangeeta Mehta ₄ , Deborah J Cook ₅ , J Gordon Boyd ₆ , Stephanie Sibley ₁ , Han T Wang ₇ , Patrick M Archambault _{8,

9} , Martin Albert ₁₀ , Oleksa G Rewa ₂ , Ian Ball ₁₁ , Patrick A Norman ₁₂ , Andrew G Day ₁₂ , Miranda Hunt ₁ , Osama Loubani ₁₃ , Tina Mele ₁₄ , Aimee J Sarti ₁₅ , Jason Shahin ₁₆ ,

Affiliation

Department of Critical Care Medicine, Kingston Health Sciences Center, Queen's University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada.
Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Canada.
School of Rehabilitation Science, Faculty of Health Science, Physiotherapy Department, McMaster University, St. Joseph's Healthcare, Hamilton, ON, Canada.
Interdepartmental Division of Critical Care Medicine, Department of Medicine, Sinai Health System, University of Toronto, Toronto, ON, Canada.
Departments of Medicine, Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
Department of Medicine (Neurology) and Critical Care Medicine, Queen's University, Kingston, ON, Canada.
Division of Critical Care Medicine, Department of Medicine, Centre Hospitalier de L'Universite de Montreal, Montreal, QC, Canada.
Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada.
Department of Anesthesiology and Intensive Care, Faculty of Medicine, Université Laval, Québec, QC, Canada.
Division of Critical Care Medicine, Department of Medicine, Hôpital du Sacré-Coeur de Montréal Research Center and Université de Montréal, Montreal, QC, Canada.
Department of Medicine and Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
Kingston General Health Research Institute and Kingston Health Sciences Centre, Kingston, Canada.
Department of Critical Care, Dalhousie University, Halifax, ON, Canada.
Department of Surgery, University of Western Ontario, London, ON, Canada.
Department of Critical Care, The Ottawa Hospital, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Department of Medicine, McGill University, Montreal, Qc, Canada.

Purpose

Frailty is common in critically ill patients but the timing and optimal method of frailty ascertainment, trajectory and relationship with care processes remain uncertain. We sought to elucidate the trajectory and care processes of frailty in critically ill patients as measured by the Clinical Frailty Scale (CFS) and Frailty Index (FI).

Methods

This is a multi-centre prospective cohort study enrolling patients ≥ 50 years old receiving life support > 24 h. Frailty severity was assessed with a CFS, and a FI based on the elements of a comprehensive geriatric assessment (CGA) at intensive care unit (ICU) admission, hospital discharge and 6 months. For the primary outcome of frailty prevalence, it was a priori dichotomously defined as a CFS ≥ 5 or FI ≥ 0.2. Processes of care, adverse events were collected during ICU and ward stays while outcomes were determined for ICU, hospital, and 6 months.

Results

In 687 patients, whose age (mean ± standard deviation) was 68.8 ± 9.2 years, frailty prevalence was higher when measured with the FI (CFS, FI %): ICU admission (29.8, 44.8), hospital discharge (54.6, 67.9), 6 months (34.1, 42.6). Compared to ICU admission, aggregate frailty severity increased to hospital discharge but improved by 6 months; individually, CFS and FI were higher in 45.3% and 50.6% patients, respectively at 6 months. Compared to hospital discharge, 18.7% (CFS) and 20% (FI) were higher at 6 months. Mortality was higher in frail patients. Processes of care and adverse events were similar except for worse ICU/ward mobility and more frequent delirium in frail patients.

Conclusions

Frailty severity was dynamic, can be measured during recovery from critical illness using the CFS and FI which were both associated with worse outcomes. Although the CFS is a global measure, a CGA FI based may have advantages of being able to measure frailty levels, identify deficits, and potential targets for intervention.

中文翻译：

危重患者的虚弱、结果、康复和护理步骤 (FORECAST)：一项前瞻性、多中心队列研究

目的

虚弱在危重患者中很常见，但虚弱确定的时机和最佳方法、轨迹以及与护理过程的关系仍然不确定。我们试图通过临床衰弱量表（CFS）和衰弱指数（FI）来阐明危重患者衰弱的轨迹和护理过程。

方法

这是一项多中心前瞻性队列研究，招募 ≥ 50 岁接受生命支持 > 24 小时的患者。根据重症监护病房 (ICU) 入院、出院和 6 个月时综合老年评估 (CGA) 的要素，通过 CFS 和 FI 评估虚弱严重程度。对于衰弱患病率的主要结果，先验二分法定义为 CFS ≥ 5 或 FI ≥ 0.2。收集 ICU 和病房住院期间的护理过程、不良事件，同时确定 ICU、住院和 6 个月的结果。

结果

在 687 名年龄（平均值±标准差）为 68.8 ± 9.2 岁的患者中，使用 FI 测量时，虚弱患病率较高（CFS，FI %）：入住 ICU（29.8，44.8），出院（54.6，67.9）， 6 个月（34.1，42.6）。与入住 ICU 相比，出院时总体虚弱严重程度有所增加，但改善了 6 个月；就个体而言，6 个月时，CFS 和 FI 分别在 45.3% 和 50.6% 的患者中较高。与出院相比，6 个月时的死亡率为 18.7% (CFS) 和 20% (FI)。体弱患者的死亡率较高。护理过程和不良事件相似，但 ICU/病房的流动性较差，体弱患者出现谵妄的情况较多。