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A “fragilidade” nos idosos admitidos numa UCI polivalente : observação retrospectiva do seu impacto sobre a mortalidade hospitalar e aos 6 meses
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Introdução: Fragilidade (“frailty”) é definida como uma síndrome multidimensional de perda de reservas funcionais, que aumenta a vulnerabilidade de um indivíduo em termos de saúde. Objectivo: Determinar o eventual grau de impacto da fragilidade no prognóstico de doentes idosos internados numa unidade de cuidados intensivos (UCI) polivalentes, num hospital universitário. Materiais e métodos: Estudo retrospectivo de 1 ano (de 1/01/2013 a 31/12/2013) de 160 pacientes, com idades ≥ 65 anos, de entre um número total de 398 internamentos consecutivos. Foi aplicada a “Clinical Frailty Scale” (CFS) para avaliar o grau de fragilidade de cada paciente. Foram documentados, para além dos índices de gravidade SAPS II à entrada, e do SOFA máximo, o tempo de internamento (“LOS” - UCI e hospitalar), e ainda as mortalidades na UCI, hospitalar, e na comunidade, aos seis meses. Resultados: 48 pacientes foram considerados “frágeis” (prevalência de 30%). Eram estes os mais velhos, e com maior número de comorbilidades. Todavia à admissão não se verificaram diferenças significativas de gravidade pelo SAPS II ou pelo SOFA. Relativamente ao LOS também não foram observadas diferenças entre pacientes “frágeis” e “não frágeis”. Porém a mortalidade hospitalar e aos 6 meses foi significativamente superior nos pacientes “frágeis”. Em concordância com estudos anteriores a fragilidade demonstrou ser um factor de risco independente de morte aos 6 meses. Adicionalmente, a fragilidade demonstrou neste estudo ser factor de risco independente de morte na UCI. Conclusão: Independentemente da idade e da gravidade da doença crítica, os dados deste estudo sugerem que a avaliação da “fragilidade” dos idosos pela CFS permitirá a instituição de terapêuticas dirigidas que melhorem o prognóstico dos pacientes frágeis, e constituirá um elemento adicional no processo de tomada de decisão de limitação de terapêutica no contexto de medicina intensiva. Considera-se que a utilidade deste marcador venha a ser avaliada nesse contexto em estudos futuros.
Introduction: Frailty is defined as a multidimensional syndrome of loss of functional reserves that increases the vulnerability of an individual in terms of health. Objective: To determine the eventual impact of frailty in the prognosis of elderly patients admitted to an intensive care unit in a university hospital. Materials and methods: Retrospective study of one year (from 1/01/2013 to 31/12/2013) that included 160 patients with more than 65 years old, from a total of 398 consecutive admissions. The Clinical Frailty Scale (CFS) was applied to evaluate the degree of frailty of each patient. For each patient it was recorded the SAPS II at the time of admission, the maximum SOFA, the ICU and hospital lengths of stay (LOS), and the ICU, hospital and 6-month mortality. Results: 48 patients were considered frail (30% prevalence). Those were the older patients and with more comorbidities. There were no significant differences of severity of the acute illness assessed with SAPS II and SOFA. Also for the LOS no differences were observed between frail and non frail patients. However, the hospital and 6 month mortalities were higher in the frail patients. Like in previous studies frailty proved to be an independent risk factor for death at 6 months. Additionally, in this study, frailty proved to be an independent risk factor for ICU mortality. Conclusions: Regardless of the age and severity of the critical illness, the data suggest that the evaluation of frailty in elderly patients, using CFS, may enable the therapeutic intervention directed to frail patients and may also constitute an additional element to the decision of limitation of treatment. We consider that the utility of this marker is to be evaluated in this context.
Introduction: Frailty is defined as a multidimensional syndrome of loss of functional reserves that increases the vulnerability of an individual in terms of health. Objective: To determine the eventual impact of frailty in the prognosis of elderly patients admitted to an intensive care unit in a university hospital. Materials and methods: Retrospective study of one year (from 1/01/2013 to 31/12/2013) that included 160 patients with more than 65 years old, from a total of 398 consecutive admissions. The Clinical Frailty Scale (CFS) was applied to evaluate the degree of frailty of each patient. For each patient it was recorded the SAPS II at the time of admission, the maximum SOFA, the ICU and hospital lengths of stay (LOS), and the ICU, hospital and 6-month mortality. Results: 48 patients were considered frail (30% prevalence). Those were the older patients and with more comorbidities. There were no significant differences of severity of the acute illness assessed with SAPS II and SOFA. Also for the LOS no differences were observed between frail and non frail patients. However, the hospital and 6 month mortalities were higher in the frail patients. Like in previous studies frailty proved to be an independent risk factor for death at 6 months. Additionally, in this study, frailty proved to be an independent risk factor for ICU mortality. Conclusions: Regardless of the age and severity of the critical illness, the data suggest that the evaluation of frailty in elderly patients, using CFS, may enable the therapeutic intervention directed to frail patients and may also constitute an additional element to the decision of limitation of treatment. We consider that the utility of this marker is to be evaluated in this context.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2015
Palavras-chave
Idoso Cuidados intensivos Unidades de cuidados intensivos Resultados de cuidados intensivos