İç Hastalıkları Yoğun Bakımına Yatan Yaşlı Hastalarda Kırılganlığın ve Etkilerinin Değerlendirilmesi

Abstract

Frailty is a medical syndrome with multiple contributing factors and causes, characterized by decreased physical function, endurance and reduced strength, which increases the risk of death and dependence in daily life. Prevalence ranges between 3% and 23% for individuals in the population and between 27% and 80% for inpatients. It has numerous negative effects on the patient and the medical expenses but its effects can be improved if diagnosed. The frail geriatric patients who are admitted to hospital admission and intensive care unit have the risk of increased mortality, morbidity, fall and placement in a care facility. Determination of frailty in intensive care units with limited number of beds is effective in the prognosis and decision making process of patients. In this study, we aimed to diagnose frailty in elderly patients that are admitted to intensive care unit due to any reason using readily usable and practical methods and evaluate the effects on bad health outcomes. A total of 69 patients (38 female and 31 male) over 65 years of age were included in the study. Clinical frailty scale(CFS) and Edmonton frailty scale(EFS) were used to determine the frailty based on clinical condition before acute problem. Acute Physiology and Chronic Health Evaluation-2 (APACHE-2) score, first day Sequential Organ Failure Assessment (SOFA) score, first day Glaskow coma scale(GCS), noninvasive mechanical ventilation (NIMV) and invasive mechanical ventilation (IMV) requirement and duration, nutrition risk in the critically ill (NUTRIC) score, tube feeding and duration, intensive care and hospital mortality were calculated and laboratory data were recorded. Frailty was assessed using CFS and EFS. After the discharge, the caregiver of patient was interviewed on the first month, the second month, and the third month, CFS was reapplied; and mortality, emergency service admission, and intensive care admission information were obtained. The frequency of frailty was 59.4% according to CFS and 60.8% according to EFS on admission. EFS score and CFS score showed a strong positive correlation (r: 0.867 p <0.001). According to the CFS, the frailty was higher in women. It was determined that the prevalence of fraility increased with age. The average age of the frail group was significantly higher . According to EFS, frail group had significantly a high hospital admission rate in the previous year, high number of medicines and a number of comorbidities compared to the non frail group. Vitamin B12 levels were significantly lower in the frail group than in the non – frail group in both scales. According to EFS, there was no statistically significant difference between the two groups in terms of pressure sores, delirium, ICU mortality, hospital mortality, mechanical ventilation requirement, and duration APACHE-2 score, SOFA score. According to the CFS, length of stay in ICU and pressure sore prevalence were significantly higher in the frail group. Number of patients with a high risk of malnutrition according to the NUTRIC score was significantly higher in the frail group. In addition, patients with high risk of malnutrition showed significantly higher IMV requirement, more pressure sore, higher ICU mortality, hospital and post-discharge mortality when compared to patients with low risk of malnutrition. According to CFS, post-discharge mortality was significantly higher in the frail group than non frail group. There was a significantly deterioration in post discharge CFS score when compared to CFS score before intensive care unit. Multivariate analysis showed that NUTRIC score (OR 2,01, %95 CI 1,1-3,5 , p: 0.016 ) was the independent correlate for ICU mortality. Additionally, NUTRIC score and pressure sore were found to be significantly independent correlates for 30th day, 60th day, 90th day mortality after discharge in multivariate analysis. Kaplan Mayer survival analysis showed that decreased survival in CFS frail group(p:0.005) but not in EFS frail group (p:0.143).