Scholarlink

Background <p>Traditional predictors of weaning outcomes primarily focus on acute illness severity and physiological parameters, while geriatric vulnerability domains such as frailty, functional dependence, and nutritional risk are often overlooked. Evidence regarding the incremental prognostic value of these domains for predicting weaning failure in critically ill older patients remains limited. This study aimed to evaluate the association between pre-admission frailty, functional status, comorbidity burden, and acute organ dysfunction with weaning failure in critically ill patients aged ≥ 65 years, and to compare their prognostic contribution with traditional severity scores.</p> Methods <p>This study is a secondary analysis of a national, multicenter, prospective observational cohort conducted across adult ICUs in Türkiye. Consecutive ICU patients aged ≥ 65 years who required invasive mechanical ventilation for more than 24&#xa0;h were included. Multivariable logistic regression was used to identify factors independently associated with weaning failure. Weaning failure was defined as the need for reintubation within 7 days after extubation, death during the weaning process, or persistent requirement for invasive mechanical ventilation at day 90. Model discrimination was assessed using the area under the receiver operating characteristic curve (AUC).</p> Results <p>A total of 647 critically ill older patients were included in the study. Weaning failure occurred in 347 patients (53.6%). There was no significant difference in age between patients with weaning failure and those successfully weaned. Patients with weaning failure had significantly higher frailty scores, greater comorbidity burden, more severe organ dysfunction, higher nutritional risk, and worse functional dependency. In the final multivariable logistic regression model, higher Clinical Frailty Scale (CFS) (aOR = 1.26 per point; 95% CI = 1.16–1.38) and higher Sequential Organ Failure Assessment (SOFA) score (aOR = 1.12 per point; 95% CI = 1.06–1.19) were independently associated with weaning failure.</p> Conclusions <p>In critically ill older patients, frailty and early organ dysfunction were the factors most strongly associated with weaning failure, whereas chronological age alone showed limited prognostic value, supporting a shift from age-based to vulnerability-based risk assessment.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Predicting weaning failure in critically ill older patients: secondary analysis of a national multicenter prospective cohort in Türkiye

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年4月23日

查看全文
  • Umut Sabri Kasapoglu,
  • Ozlem Yazicioglu Mocin,
  • Eylem Tuncay,
  • Sinem Gungor,
  • Huseyin Arikan,
  • Ozlem Ediboglu,
  • Nazlı Huma Teke,
  • Eda Macit Aydin,
  • Berkay Kucuk,
  • Dursun Ali Saglam,
  • Deniz Celik,
  • Ozkan Yetkin,
  • Huseyin Lakadamyali,
  • Ugur Altun,
  • Ahmet Yurttas,
  • Cemile Altın,
  • Baris Yilmaz,
  • Gul Erdal Donmez,
  • Gulcin Hilal Alay,
  • Feyzullah Kolay,
  • Mahmut Baran Kasisari,
  • Rezan Serefoglu,
  • Fethi Gul,
  • Esra Tekin,
  • Hicran Kocak,
  • Mehmet Suleyman Sabaz,
  • Esra Cankaya,
  • Melike Bektas,
  • Seda Seven Inci,
  • Seher Yanatma,
  • Ahmet Duzgun,
  • Leman Acun Delen,
  • Murat Bicakcioglu,
  • Ayse Belin Ozer,
  • Lutfiye Serap Avlagi,
  • Alkim Gizem Yilmaz Selimoglu,
  • Ahmet Oguzhan Kucuk,
  • Duygu Ozdemir Simsek,
  • Banu Kilicaslan,
  • Seda Banu Akinci,
  • Mucahid Colak,
  • Yusuf Aydemir,
  • Gulsum Altuntas,
  • Faruk Yildiz,
  • Volkan Inal,
  • Kaniye Aydin,
  • Mehmet Gokhan Gok,
  • Sevda Onuk,
  • Huseyin Ozkok,
  • Selcuk Yaylaci,
  • Emre Aydin,
  • Fatma Yilmaz Aydin,
  • Omer Dogan,
  • Dilek Ozcengiz,
  • Neslihan Tas,
  • Omer Tamer Dogan,
  • Eren Mingsar,
  • Kamil Gonderen,
  • Ismail Yildiz,
  • Sinem Iliaz,
  • Hatice Arzu Ucar,
  • Ayse Capar,
  • Seyma Baslilar,
  • Yesim Serife Bayraktar,
  • Yasemin Cebeci,
  • Zerrin Ozcelik,
  • Pinar Ozgun,
  • Nilgun Savas,
  • Korhan Kollu,
  • Hamza Gultekin,
  • Aysen Erer,
  • Ferhan Demirer Aydemir,
  • Pervin Hanci Yilmazturk,
  • Ahmet Uysal,
  • Esra Temel,
  • Veysi Tekin,
  • Hande Celik,
  • Aysen Kara,
  • Erdem Yalcinkaya,
  • Sait Karakurt,
  • Buket Mermit,
  • Beyza Yuksel,
  • Busra Nur Akdag,
  • Leyla Saglam,
  • Oner Abidin Balbay,
  • Huseyin Coskuner,
  • Nalan Demir,
  • Seyma Tunc,
  • Nesrin Ocal,
  • Burcu Ozturk Sahin,
  • Elvan Senturk Topaloglu,
  • Eylem Sercan Ozgur,
  • Demet Polat Yulug,
  • Gozde Oksuzler Kizilbay,
  • Oguzhan Kayhan,
  • Oktay Demirkiran,
  • Kamuran Uluc,
  • Nur Kasimoglu,
  • Aysegul Tomruk Erdem,
  • Asli Melek Savas,
  • Serif Kurtulus

摘要

Background

Traditional predictors of weaning outcomes primarily focus on acute illness severity and physiological parameters, while geriatric vulnerability domains such as frailty, functional dependence, and nutritional risk are often overlooked. Evidence regarding the incremental prognostic value of these domains for predicting weaning failure in critically ill older patients remains limited. This study aimed to evaluate the association between pre-admission frailty, functional status, comorbidity burden, and acute organ dysfunction with weaning failure in critically ill patients aged ≥ 65 years, and to compare their prognostic contribution with traditional severity scores.

Methods

This study is a secondary analysis of a national, multicenter, prospective observational cohort conducted across adult ICUs in Türkiye. Consecutive ICU patients aged ≥ 65 years who required invasive mechanical ventilation for more than 24 h were included. Multivariable logistic regression was used to identify factors independently associated with weaning failure. Weaning failure was defined as the need for reintubation within 7 days after extubation, death during the weaning process, or persistent requirement for invasive mechanical ventilation at day 90. Model discrimination was assessed using the area under the receiver operating characteristic curve (AUC).

Results

A total of 647 critically ill older patients were included in the study. Weaning failure occurred in 347 patients (53.6%). There was no significant difference in age between patients with weaning failure and those successfully weaned. Patients with weaning failure had significantly higher frailty scores, greater comorbidity burden, more severe organ dysfunction, higher nutritional risk, and worse functional dependency. In the final multivariable logistic regression model, higher Clinical Frailty Scale (CFS) (aOR = 1.26 per point; 95% CI = 1.16–1.38) and higher Sequential Organ Failure Assessment (SOFA) score (aOR = 1.12 per point; 95% CI = 1.06–1.19) were independently associated with weaning failure.

Conclusions

In critically ill older patients, frailty and early organ dysfunction were the factors most strongly associated with weaning failure, whereas chronological age alone showed limited prognostic value, supporting a shift from age-based to vulnerability-based risk assessment.