Association between frailty and short- and long-term outcomes among critically ill patients: a multicentre prospective cohort study

Bagshaw, Sean M.; Stelfox, Henry T.; McDermid, Robert C.; Rolfson, Darryl; Tsuyuki, Ross T.; Baig, Nadia; Artiuch, Barbara; Ibrahim, Quazi; Stollery, Daniel; Rokosh, Ella; Majumdar, Sumit R.

doi:10.1503/cmaj.130639

Cited by 402 publications

(485 citation statements)

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“…It builds further on prior work and affirms patients admitted to ICU can be screened for frailty using a relatively simple tool, to provide a global impression of pre-hospital function [1][2][3]. Moreover, the CFS score appears to reliably predict a subgroup more likely to die within 30 daysconfirming construct validity.…”

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confidence: 64%

“…Frailty, a multi-system decline in health status resulting from the cumulative impairment of homeostatic reserve (i.e., energy, physical ability, cognition), is increasingly recognized as an important prognostic determinant of outcome among critically ill populations [1][2][3]. Frailty predisposes to disproportionate and heightened vulnerability to adverse outcomes from acute stressors such as infection, surgery, or trauma.…”

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confidence: 99%

“…Frailty predisposes to disproportionate and heightened vulnerability to adverse outcomes from acute stressors such as infection, surgery, or trauma. As many as one-third of adult critically ill patients admitted to the intensive care unit (ICU) have been shown to be screened as frail, with the prevalence increasing with older age [1,2,4].…”

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confidence: 99%

“…In the VIP study, frailty status was ascertained by screening patients using the Clinical Frailty Scale (CFS) score at the time of ICU admission [1,2]. The CFS is a previously validated judgment-based tool that can be relatively simple to use to screen patients on an visual analogue and ordinal scale (range 1-9), with higher scores representing greater degrees of frailty [1,2,9].…”

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confidence: 99%

“…The CFS is a previously validated judgment-based tool that can be relatively simple to use to screen patients on an visual analogue and ordinal scale (range 1-9), with higher scores representing greater degrees of frailty [1,2,9]. In the VIP study, the CFS was assigned by bedside physicians and nurses and aimed to integrate patient information or surrogate reporting of patient status immediately prior to the current illness.…”

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confidence: 99%

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Frailty in the age of VIPs (very old intensive care patients)

Montgomery

Bagshaw

2017

Intensive Care Med

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confidence: 64%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Frailty in the age of VIPs (very old intensive care patients)

Montgomery

Bagshaw

2017

Intensive Care Med

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Outcomes for older adults with acute myeloid leukemia after an intensive care unit admission

Slavin

Fenech

Jankowski

et al. 2019

Cancer

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BACKGROUND: Older adults with acute myeloid leukemia (AML) are often assumed to have poor outcomes after admission to the intensive care unit (ICU). However, little is known about ICU utilization and post-ICU outcomes in this population. METHODS: The authors conducted a retrospective analysis for 330 patients who were 60 years old or older and were diagnosed with AML between 2005 and 2013 at 2 hospitals in Boston.They used descriptive statistics to examine the proportion of patients admitted to the ICU as well as their mortality and functional recovery. They used logistic regression to identify risk factors for in-hospital mortality. RESULTS: Ninety-six patients (29%) were admitted to the ICU, primarily because of respiratory failure (39%), septic shock (28%), and neurological compromise (9%). The proportions of patients who survived to hospital discharge, 90 days, and 1 year were 47% (45 of 96), 35% (34 of 96), and 30% (29 of 96), respectively. At 90 days, 76% of the patients had an Eastern Cooperative Oncology Group performance status (ECOG PS) of 0 or 1, and 86% were in complete remission (CR) and/or continued to receive AML-directed therapy. In a multivariate analysis, a poorer baseline ECOG PS score (odds ratio, 2.76; P = .013) and the need for 2 or more life-sustaining therapies (ie, vasopressors, invasive ventilation, and/or renal replacement therapy; odds ratio, 12.4; P < .001) were associated with increased odds of in-hospital mortality. CONCLUSIONS: Although almost one-third of older patients with AML are admitted to an ICU, nearly half survive to hospital discharge with good functional outcomes. The baseline performance status and the need for 2 or more life-sustaining therapies predict hospital mortality. These data support the judicious use of ICU resources for older patients with AML. Cancer 2019;125:3845-3852.

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Clinical frailty, and not features of acute infection, is associated with late mortality in COVID‐19: a retrospective cohort study

Vlachogiannis

Baker

Georgiopoulos

et al. 2022

J cachexia sarcopenia muscle

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Background Coronavirus disease 2019 (COVID‐19) is associated with excess mortality after hospital discharge. Identification of patients at increased risk of death following hospital discharge is needed to guide clinical monitoring and early intervention. Herein, we aimed to identify predictors of early vs. late mortality in COVID‐19 patients. Methods A total of 471 patients with polymerase chain reaction‐confirmed COVID‐19 were followed up for 9 months [median (inter‐quartile range) of follow‐up time: 271 (14) days] after hospital admission. COVID‐19‐related signs and symptoms, laboratory features, co‐morbidities, Coronavirus Clinical Characterisation Consortium (4C) mortality and Clinical Frailty Scale (CFS) scores were analysed by logistic regression for association with early (28 day) vs. late mortality. Receiver operating characteristic (ROC) analysis was used to determine the discriminative value of 4C and CFS scores for early vs. late mortality. Results A total of 120 patients died within 28 days from hospital admission. Of the remaining 351 patients, 41 died within the next 8 months. Respiratory failure, systemic inflammation, and renal impairment were associated with early mortality, while active cancer and dementia were associated with late mortality, after adjustment for age and sex. 4C mortality score and CFS were associated with both early [odds ratio (OR) (95% confidence interval—CI): 4C : 1.34 (1.25–1.45); CFS : 1.49 (1.33–1.66)] and late [OR (95% CI): 4C : 1.23 (1.12–1.36); CFS : 2.04 (1.62–2.56)] mortality. After adjustment for CFS, the association between 4C and late mortality was lost. By ROC analysis, 4C mortality score was superior to CFS for 28 day mortality [area under the curve (AUC) (95% CI): 0.779 (0.732–0.825) vs. 0.723 (0.673–0.773), respectively; P = 0.039]. In contrast, CFS had higher predictive value for late mortality compared with 4C mortality score [AUC (95% CI): 0.830 (0.776–0.883) vs. 0.724 (0.650–0.798), respectively; P = 0.007]. Conclusions In our cohort, late mortality in COVID‐19 patients is more strongly associated with premorbid clinical frailty than with severity of the acute infection phase.

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Association between frailty and short- and long-term outcomes among critically ill patients: a multicentre prospective cohort study

Cited by 402 publications

References 40 publications

Frailty in the age of VIPs (very old intensive care patients)

Frailty in the age of VIPs (very old intensive care patients)

Outcomes for older adults with acute myeloid leukemia after an intensive care unit admission

Clinical frailty, and not features of acute infection, is associated with late mortality in COVID‐19: a retrospective cohort study

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