ICM:衰弱对院外心脏骤停后死亡率、功能结局及健康状况的影响：来自TTM2试验的见解

Abstract

Purpose: To explore the association of frailty with mortality, functional outcome, and health status after out-of-hospital cardiac arrest.

目的：探讨衰弱与院外心脏骤停后死亡率、功能结局及健康状况的关联。

Methods: This is a cohort-based secondary analysis of the Targeted Hypothermia versus Targeted Normothermia after out-of-hospital cardiac arrest (TTM2) trial, an international, prospective, multicentre study. Frailty was assessed using the Clinical Frailty Scale (1-9): fit (1-3), prefrail (4), frail (5), and severely frail (6-9). Main outcomes were mortality and poor functional outcome (modified Rankin Scale 4-6) at 6 and 24 months. Additional outcomes included neuroprognostication, withdrawal-of-life-sustaining-therapies (WLST), functional decline (retrospectively reported pre-arrest versus 6 month Glasgow Outcome Scale Extended score), health status (EQ-5D-5L, EQ-VAS), and life satisfaction at 6 and 24 months.

方法：本研究为基于队列的二次分析，数据来源于“院外心脏骤停后目标低温与目标常温对比试验（TTM2）”——一项国际、前瞻性、多中心研究。采用临床衰弱量表（CFS，评分1-9分）评估衰弱程度，分为：健康（1-3分）、衰弱前期（4分）、衰弱（5分）、重度衰弱（6-9分）。主要结局为6个月和24个月的死亡率及不良功能结局（改良Rankin量表评分4-6分）。次要结局包括神经预后评估、撤除生命支持治疗（WLST）、功能下降（回顾性报告的骤停前与6个月格拉斯哥结局量表扩展版[GOS-E]评分对比）、健康状况（EQ-5D-5L量表、EQ视觉模拟评分[EQ-VAS]）及6个月和24个月的生活满意度。

Results: Of 1861 participants, 240 (13%) were prefrail, and 188 (10%) were frail or severely frail. Mortality and poor functional outcome increased significantly with greater frailty. Compared to fit participants, adjusted ORs (95% CI) for 6 month mortality were: prefrail 2.7 (1.8-3.8), frail 3.7 (1.9-7.1), and severely frail 8.9 (4.2-18.7); and poor functional outcome: prefrail 2.9 (1.9-4.2), frail 3.9 (1.9-8.1), and severely frail 35.4 (8.4-148.8). Severely frail participants underwent neuroprognostication less often (p < 0.001), while WLST was more common in the prefrail, frail and severely frail (p < 0.001). Prefrail and frail survivors tended to report more frequent functional decline and lower health status, though with individual variation.

结果：在1861例参与者中，240例（13%）为衰弱前期，188例（10%）为衰弱或重度衰弱。死亡率与不良功能结局随衰弱程度加重显著升高：与“健康”参与者相比，6个月死亡率的校正比值比（OR，95%置信区间）为：衰弱前期2.7（1.8-3.8）、衰弱3.7（1.9-7.1）、重度衰弱8.9（4.2-18.7）；6个月不良功能结局的校正OR为：衰弱前期2.9（1.9-4.2）、衰弱3.9（1.9-8.1）、重度衰弱35.4（8.4-148.8）。此外，重度衰弱参与者接受神经预后评估的频率更低（p<0.001）；而衰弱前期、衰弱及重度衰弱患者的撤除生命支持治疗（WLST）更常见（p<0.001）。衰弱前期与衰弱幸存者的功能下降更频繁、健康状况更差（尽管存在个体差异）。

Conclusion: Frailty was associated with a significantly increased risk of mortality and poor functional outcome after out-of-hospital cardiac arrest. Findings suggest more frequent functional decline and lower overall health status in frail survivors.

结论：衰弱与院外心脏骤停后死亡率及不良功能结局风险显著增加相关。研究提示，衰弱幸存者更易出现功能下降，且整体健康状况更差。