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

作者：John Muscedere, Sean M. Bagshaw, Michelle E. Kho, Sangeeta Mehta, Deborah J. Cook, J. Gordon Boyd, Stephanie Sibley, Han Ting Wang, Patrick Archambault, Martin Albert, Oleksa Rewa, Ian Ball, Patrick A. Norman, Andrew G. Day, Miranda Hunt, Osama Loubani, Tina Mele, Aimee Sarti, Jason Shahin, the Canadian Critical Care Trials Group · 发表于：Intensive Care Medicine · 年份：2024 · DOI：10.1007/s00134-024-07404-9 · 被引用次数：59 · 研究领域：Frailty in Older Adults、Intensive Care Unit Cognitive Disorders、Sepsis Diagnosis and Treatment

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 ad...