دورية أكاديمية
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Using the Hospital Frailty Risk Score to assess mortality risk in older medical patients admitted to the intensive care unit.

التفاصيل البيبلوغرافية
العنوان: Using the Hospital Frailty Risk Score to assess mortality risk in older medical patients admitted to the intensive care unit.
المؤلفون: Detsky ME; Department of Medicine (Detsky, Fralick, Munshi, Kwan), Sinai Health System; Interdepartmental Division of Critical Care Medicine (Detsky, Munshi), University of Toronto; Department of Medicine (Detsky, Fralick, Munshi, Lapointe-Shaw, Tang, Kwan, Weinerman, Verma), University of Toronto; Li Ka Shing Knowledge Institute (Shin, Razak, Verma), St. Michael's Hospital; Division of Allergy, Pulmonary and Critical Care (Kruser), Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisc.; Department of Medicine (Courtright) and Palliative and Advanced Illness Research Center (Courtright), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.; Division of General Internal Medicine (Lapointe-Shaw, Rawal), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Department of Medicine (Razak, Verma), St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Razak, Verma), University of Toronto, Toronto, Ont. michael.detsky@sinaihealth.ca., Shin S; Department of Medicine (Detsky, Fralick, Munshi, Kwan), Sinai Health System; Interdepartmental Division of Critical Care Medicine (Detsky, Munshi), University of Toronto; Department of Medicine (Detsky, Fralick, Munshi, Lapointe-Shaw, Tang, Kwan, Weinerman, Verma), University of Toronto; Li Ka Shing Knowledge Institute (Shin, Razak, Verma), St. Michael's Hospital; Division of Allergy, Pulmonary and Critical Care (Kruser), Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisc.; Department of Medicine (Courtright) and Palliative and Advanced Illness Research Center (Courtright), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.; Division of General Internal Medicine (Lapointe-Shaw, Rawal), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Department of Medicine (Razak, Verma), St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Razak, Verma), University of Toronto, Toronto, Ont., Fralick M; Department of Medicine (Detsky, Fralick, Munshi, Kwan), Sinai Health System; Interdepartmental Division of Critical Care Medicine (Detsky, Munshi), University of Toronto; Department of Medicine (Detsky, Fralick, Munshi, Lapointe-Shaw, Tang, Kwan, Weinerman, Verma), University of Toronto; Li Ka Shing Knowledge Institute (Shin, Razak, Verma), St. Michael's Hospital; Division of Allergy, Pulmonary and Critical Care (Kruser), Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisc.; Department of Medicine (Courtright) and Palliative and Advanced Illness Research Center (Courtright), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.; Division of General Internal Medicine (Lapointe-Shaw, Rawal), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Department of Medicine (Razak, Verma), St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Razak, Verma), University of Toronto, Toronto, Ont., Munshi L; Department of Medicine (Detsky, Fralick, Munshi, Kwan), Sinai Health System; Interdepartmental Division of Critical Care Medicine (Detsky, Munshi), University of Toronto; Department of Medicine (Detsky, Fralick, Munshi, Lapointe-Shaw, Tang, Kwan, Weinerman, Verma), University of Toronto; Li Ka Shing Knowledge Institute (Shin, Razak, Verma), St. Michael's Hospital; Division of Allergy, Pulmonary and Critical Care (Kruser), Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisc.; Department of Medicine (Courtright) and Palliative and Advanced Illness Research Center (Courtright), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.; Division of General Internal Medicine (Lapointe-Shaw, Rawal), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Department of Medicine (Razak, Verma), St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Razak, Verma), University of Toronto, Toronto, Ont., Kruser JM; Department of Medicine (Detsky, Fralick, Munshi, Kwan), Sinai Health System; Interdepartmental Division of Critical Care Medicine (Detsky, Munshi), University of Toronto; Department of Medicine (Detsky, Fralick, Munshi, Lapointe-Shaw, Tang, Kwan, Weinerman, Verma), University of Toronto; Li Ka Shing Knowledge Institute (Shin, Razak, Verma), St. Michael's Hospital; Division of Allergy, Pulmonary and Critical Care (Kruser), Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisc.; Department of Medicine (Courtright) and Palliative and Advanced Illness Research Center (Courtright), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.; Division of General Internal Medicine (Lapointe-Shaw, Rawal), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Department of Medicine (Razak, Verma), St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Razak, Verma), University of Toronto, Toronto, Ont., Courtright KR; Department of Medicine (Detsky, Fralick, Munshi, Kwan), Sinai Health System; Interdepartmental Division of Critical Care Medicine (Detsky, Munshi), University of Toronto; Department of Medicine (Detsky, Fralick, Munshi, Lapointe-Shaw, Tang, Kwan, Weinerman, Verma), University of Toronto; Li Ka Shing Knowledge Institute (Shin, Razak, Verma), St. Michael's Hospital; Division of Allergy, Pulmonary and Critical Care (Kruser), Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisc.; Department of Medicine (Courtright) and Palliative and Advanced Illness Research Center (Courtright), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.; Division of General Internal Medicine (Lapointe-Shaw, Rawal), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Department of Medicine (Razak, Verma), St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Razak, Verma), University of Toronto, Toronto, Ont., Lapointe-Shaw L; Department of Medicine (Detsky, Fralick, Munshi, Kwan), Sinai Health System; Interdepartmental Division of Critical Care Medicine (Detsky, Munshi), University of Toronto; Department of Medicine (Detsky, Fralick, Munshi, Lapointe-Shaw, Tang, Kwan, Weinerman, Verma), University of Toronto; Li Ka Shing Knowledge Institute (Shin, Razak, Verma), St. Michael's Hospital; Division of Allergy, Pulmonary and Critical Care (Kruser), Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisc.; Department of Medicine (Courtright) and Palliative and Advanced Illness Research Center (Courtright), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.; Division of General Internal Medicine (Lapointe-Shaw, Rawal), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Department of Medicine (Razak, Verma), St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Razak, Verma), University of Toronto, Toronto, Ont., Tang T; Department of Medicine (Detsky, Fralick, Munshi, Kwan), Sinai Health System; Interdepartmental Division of Critical Care Medicine (Detsky, Munshi), University of Toronto; Department of Medicine (Detsky, Fralick, Munshi, Lapointe-Shaw, Tang, Kwan, Weinerman, Verma), University of Toronto; Li Ka Shing Knowledge Institute (Shin, Razak, Verma), St. Michael's Hospital; Division of Allergy, Pulmonary and Critical Care (Kruser), Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisc.; Department of Medicine (Courtright) and Palliative and Advanced Illness Research Center (Courtright), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.; Division of General Internal Medicine (Lapointe-Shaw, Rawal), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Department of Medicine (Razak, Verma), St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Razak, Verma), University of Toronto, Toronto, Ont., Rawal S; Department of Medicine (Detsky, Fralick, Munshi, Kwan), Sinai Health System; Interdepartmental Division of Critical Care Medicine (Detsky, Munshi), University of Toronto; Department of Medicine (Detsky, Fralick, Munshi, Lapointe-Shaw, Tang, Kwan, Weinerman, Verma), University of Toronto; Li Ka Shing Knowledge Institute (Shin, Razak, Verma), St. Michael's Hospital; Division of Allergy, Pulmonary and Critical Care (Kruser), Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisc.; Department of Medicine (Courtright) and Palliative and Advanced Illness Research Center (Courtright), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.; Division of General Internal Medicine (Lapointe-Shaw, Rawal), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Department of Medicine (Razak, Verma), St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Razak, Verma), University of Toronto, Toronto, Ont., Kwan JL; Department of Medicine (Detsky, Fralick, Munshi, Kwan), Sinai Health System; Interdepartmental Division of Critical Care Medicine (Detsky, Munshi), University of Toronto; Department of Medicine (Detsky, Fralick, Munshi, Lapointe-Shaw, Tang, Kwan, Weinerman, Verma), University of Toronto; Li Ka Shing Knowledge Institute (Shin, Razak, Verma), St. Michael's Hospital; Division of Allergy, Pulmonary and Critical Care (Kruser), Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisc.; Department of Medicine (Courtright) and Palliative and Advanced Illness Research Center (Courtright), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.; Division of General Internal Medicine (Lapointe-Shaw, Rawal), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Department of Medicine (Razak, Verma), St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Razak, Verma), University of Toronto, Toronto, Ont., Weinerman A; Department of Medicine (Detsky, Fralick, Munshi, Kwan), Sinai Health System; Interdepartmental Division of Critical Care Medicine (Detsky, Munshi), University of Toronto; Department of Medicine (Detsky, Fralick, Munshi, Lapointe-Shaw, Tang, Kwan, Weinerman, Verma), University of Toronto; Li Ka Shing Knowledge Institute (Shin, Razak, Verma), St. Michael's Hospital; Division of Allergy, Pulmonary and Critical Care (Kruser), Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisc.; Department of Medicine (Courtright) and Palliative and Advanced Illness Research Center (Courtright), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.; Division of General Internal Medicine (Lapointe-Shaw, Rawal), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Department of Medicine (Razak, Verma), St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Razak, Verma), University of Toronto, Toronto, Ont., Razak F; Department of Medicine (Detsky, Fralick, Munshi, Kwan), Sinai Health System; Interdepartmental Division of Critical Care Medicine (Detsky, Munshi), University of Toronto; Department of Medicine (Detsky, Fralick, Munshi, Lapointe-Shaw, Tang, Kwan, Weinerman, Verma), University of Toronto; Li Ka Shing Knowledge Institute (Shin, Razak, Verma), St. Michael's Hospital; Division of Allergy, Pulmonary and Critical Care (Kruser), Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisc.; Department of Medicine (Courtright) and Palliative and Advanced Illness Research Center (Courtright), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.; Division of General Internal Medicine (Lapointe-Shaw, Rawal), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Department of Medicine (Razak, Verma), St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Razak, Verma), University of Toronto, Toronto, Ont., Verma AA; Department of Medicine (Detsky, Fralick, Munshi, Kwan), Sinai Health System; Interdepartmental Division of Critical Care Medicine (Detsky, Munshi), University of Toronto; Department of Medicine (Detsky, Fralick, Munshi, Lapointe-Shaw, Tang, Kwan, Weinerman, Verma), University of Toronto; Li Ka Shing Knowledge Institute (Shin, Razak, Verma), St. Michael's Hospital; Division of Allergy, Pulmonary and Critical Care (Kruser), Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisc.; Department of Medicine (Courtright) and Palliative and Advanced Illness Research Center (Courtright), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.; Division of General Internal Medicine (Lapointe-Shaw, Rawal), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Department of Medicine (Razak, Verma), St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Razak, Verma), University of Toronto, Toronto, Ont.
المصدر: CMAJ open [CMAJ Open] 2023 Jul 04; Vol. 11 (4), pp. E607-E614. Date of Electronic Publication: 2023 Jul 04 (Print Publication: 2023).
نوع المنشور: Journal Article; Research Support, N.I.H., Extramural
اللغة: English
بيانات الدورية: Publisher: Canadian Medical Association Country of Publication: Canada NLM ID: 101620603 Publication Model: Electronic-Print Cited Medium: Internet ISSN: 2291-0026 (Electronic) Linking ISSN: 22910026 NLM ISO Abbreviation: CMAJ Open Subsets: MEDLINE
أسماء مطبوعة: Original Publication: Ottawa : Canadian Medical Association, [2013]-[2023]
مواضيع طبية MeSH: Frailty*/diagnosis , Frailty*/epidemiology, Humans ; Aged ; Retrospective Studies ; Hospital Mortality ; Intensive Care Units ; Ontario/epidemiology ; Risk Factors ; Hospitals
مستخلص: Background: Prognostic information at the time of hospital discharge can help guide goals-of-care discussions for future care. We sought to assess the association between the Hospital Frailty Risk Score (HFRS), which may highlight patients' risk of adverse outcomes at the time of hospital discharge, and in-hospital death among patients admitted to the intensive care unit (ICU) within 12 months of a previous hospital discharge.
Methods: We conducted a multicentre retrospective cohort study that included patients aged 75 years or older admitted at least twice over a 12-month period to the general medicine service at 7 academic centres and large community-based teaching hospitals in Toronto and Mississauga, Ontario, Canada, from Apr. 1, 2010, to Dec. 31, 2019. The HFRS (categorized as low, moderate or high frailty risk) was calculated at the time of discharge from the first hospital admission. Outcomes included ICU admission and death during the second hospital admission.
Results: The cohort included 22 178 patients, of whom 1767 (8.0%) were categorized as having high frailty risk, 9464 (42.7%) as having moderate frailty risk, and 10 947 (49.4%) as having low frailty risk. One hundred patients (5.7%) with high frailty risk were admitted to the ICU, compared to 566 (6.0%) of those with moderate risk and 790 (7.2%) of those with low risk. After adjustment for age, sex, hospital, day of admission, time of admission and Laboratory-based Acute Physiology Score, the odds of ICU admission were not significantly different for patients with high (adjusted odds ratio [OR] 0.99, 95% confidence interval [CI] 0.78 to 1.23) or moderate (adjusted OR 0.97, 95% CI 0.86 to 1.09) frailty risk compared to those with low frailty risk. Among patients admitted to the ICU, 75 (75.0%) of those with high frailty risk died, compared to 317 (56.0%) of those with moderate risk and 416 (52.7%) of those with low risk. After multivariable adjustment, the risk of death after ICU admission was higher for patients with high frailty risk than for those with low frailty risk (adjusted OR 2.86, 95% CI 1.77 to 4.77).
Interpretation: Among patients readmitted to hospital within 12 months, patients with high frailty risk were similarly likely as those with lower frailty risk to be admitted to the ICU but were more likely to die if admitted to ICU. The HFRS at hospital discharge can inform prognosis, which can help guide discussions for preferences for ICU care during future hospital stays.
Competing Interests: Competing interests: Amol Verma and Fahad Razak are employees of Ontario Health (Quality), which had no role in this work. Katherine Courtright receives funding from the National Institutes of Health. Jacqueline Kruser’s time was supported, in part, by the National Heart, Lung, and Blood Institute (grant K23HL146890). No other competing interests were declared.
(© 2023 CMA Impact Inc. or its licensors.)
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معلومات مُعتمدة: K23 HL146890 United States HL NHLBI NIH HHS
تواريخ الأحداث: Date Created: 20230704 Date Completed: 20230706 Latest Revision: 20230718
رمز التحديث: 20230718
مُعرف محوري في PubMed: PMC10325579
DOI: 10.9778/cmajo.20220094
PMID: 37402555
قاعدة البيانات: MEDLINE
الوصف
تدمد:2291-0026
DOI:10.9778/cmajo.20220094