Evaluating frailty may complement APACHE II in estimating mortality in elderly patients admitted to the ICU after digestive surgery

Miguelena, P. Ruiz de Gopegui; Lamazares, María Teresa Martínez; Vega, Luis Manuel Claraco; Puente, M. Gurpegui; Almárcegui, I. González; Ibañes, P. Gutiérrez; López, A. Carrillo; García, C.M. Castiella; Hycka, Javier Miguelena

doi:10.1016/j.medine.2022.02.019

Cited by 4 publications

(5 citation statements)

References 28 publications

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“…The Rockwood cumulative deficit is another commonly used approach for assessing frailty and has the advantage of incorporating health deficits across several domains, including cognition, activities of daily living, social relations or support, comorbid diseases, and abnormal laboratory results. The FI has shown good concordance with other types of frailty scores ( 28 , 29 ). Although we also assessed frailty using the Rockwood cumulative deficit, we lacked data on cognition and activities of daily living.…”

Section: Discussionmentioning

confidence: 74%

Efficacy and Safety of Dapagliflozin in Patients With Chronic Kidney Disease Across the Spectrum of Frailty

Vart,

Butt,

Jongs

et al. 2023

The Journals of Gerontology: Series A

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Background A sizeable proportion of patients with chronic kidney disease (CKD) are reported to be frail. Here we examined the safety and efficacy of dapagliflozin in patients with CKD by frailty level. Methods Adults with CKD, with/without type 2 diabetes, with estimated glomerular filtration rate (eGFR) 25–75 mL/min/1.73m 2 and urinary albumin-to-creatinine ratio 200–5000 mg/g were randomized to dapagliflozin (10 mg/day) or placebo. The primary endpoint was composite of sustained ≥50% eGFR decline, end-stage kidney disease (ESKD) or death from kidney or cardiovascular (CV) causes. Results Frailty index (FI), assessed by Rockwood cumulative deficit approach, was calculable in 4303/4304 (99.9%) patients: 1162 (27.0%) in not-to-mildly frail(FI≤0.210), 1642 (38.2%) in moderately frail(FI 0.211-0.310), and 1499 (34.8%) in severely frail categories (FI>0.311). Dapagliflozin reduced the risk of the primary composite endpoint across all FI categories (hazard ratios [95% CI]: 0.50 [0.33-0.76], 0.62 [0.45-0.85], and 0.64 [0.49-0.83], respectively (P-interaction =0.67). Results were similar for secondary outcomes including kidney composite outcome (sustained ≥50% eGFR decline, ESKD or death from kidney cause; P-interaction=0.44), CV endpoint (heart failure hospitalization or CV death; P-interaction=0.63), and all-cause mortality (P-interaction p=0.42). Results were consistent when using FI as a continuous variable. Occurrence of serious adverse events was numerically lower in patients receiving dapagliflozin vs. placebo in all FI categories (16.9% vs. 20.1%, 26.3% vs. 30.7%, and 42.9% vs 47.8%, in not-to-mildly, moderately and severely frail categories, respectively). Conclusions The relative benefit of dapagliflozin for all outcomes was consistent across all frailty categories, with no difference in associated safety.

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Section: Discussionmentioning

confidence: 74%

Efficacy and Safety of Dapagliflozin in Patients With Chronic Kidney Disease Across the Spectrum of Frailty

Vart,

Butt,

Jongs

et al. 2023

The Journals of Gerontology: Series A

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“…This was linked to their pronounced sense of independence, resulting in reduced cooperation, frequent out-of-bed activities, and an increased likelihood of inadvertently touching the drainage tube. Additionally, being elderly meant that their skin and muscle elasticity was diminished, making the drainage tube more susceptible to slipping[ 40 , 41 ]. Therefore, following the placement of the drainage tube, we must provide excellent patient education, appropriately reduce the patient’s activity level, advise the patient to protect the drainage tube, intensify nutritional support therapy for patients, aim for an early recovery, and remove the drainage tube as soon as possible[ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Closed thoracic drainage in elderly patients with chronic obstructive pulmonary disease complicated with spontaneous pneumothorax: A retrospective study

Wang,

Zhu,

Shao

et al. 2023

World J Clin Cases

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In recent years, metabolomics research has become a hot spot in the screening and treatment of cancer. It is a popular technique for the quantitative characterization of small molecular compounds in biological cells, tissues, organs or organisms. Further study of the tumor revealed that amino acid changes may occur early in the tumor. The rapid growth and metabolism required for survival result in tumors exhibiting an increased demand for amino acids. An abundant supply of amino acids is important for cancer to maintain its proliferative driving force. Changes in amino acid metabolism can be used to screen malignant tumors and improve therapeutic outcomes. Therefore, it is particularly important to study the characteristics of amino acid metabolism in colorectal cancer. This article reviews several specific amino acid metabolism characteristics in colorectal cancer.

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“…Only two previous studies have examined the role that frailty may play in modifying the accuracy of the APACHE II mortality prediction model on ICU. 14,15 Both studies describe benefit in the inclusion of frailty within the APACHE II model, raising the area under to the ROC to 0.88 (for all critically ill admissions in Australia and New Zealand) and 0.82 (for critically ill postoperative gastrointestinal surgical patients in Spain) respectively. This was very similar to the area under the ROC following inclusion of frailty in our study (0.89).…”

Section: Discussionmentioning

confidence: 99%

The impact of frailty on death, discharge destination and modelling accuracy in patients receiving organ support on the intensive care unit

Georgiou

Turner

Ruiz

et al. 2022

Journal of the Intensive Care Society

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Background This study aims to identify any effect of frailty in altering the risk of death or poor outcome already associated with receipt of organ support on ICU. It also aims to assess the performance of mortality prediction models in frail patients. Methods All admissions to a single ICU over 1-year were prospectively allocated a Clinical Frailty Score (CFS). Logistic regression analysis was used to investigate the effect of frailty on death or poor outcome (death/discharge to a medical facility). Logistic regression analysis, area under the Receiver Operator Curve (AUROC) and Brier scores were used to investigate the ability of two mortality prediction models, ICNARC and APACHE II, to predict mortality in frail patients. Results Of 849 patients, 700 (82%) patients were not frail, and 149 (18%) were frail. Frailty was associated with a stepwise increase in the odds of death or poor outcome (OR for each point rise of CFS = 1.23 ([1.03–1.47]; p = .024) and 1.32 ([1.17–1.48]; p = <.001) respectively). Renal support conferred the greatest odds of death and poor outcome, followed by respiratory support, then cardiovascular support (which increased the odds of death but not poor outcome). Frailty did not modify the odds already associated with organ support. The mortality prediction models were not modified by frailty (AUROC p = .220 and .437 respectively). Inclusion of frailty into both models improved their accuracy. Conclusions Frailty was associated with increased odds of death and poor outcome, but did not modify the risk already associated with organ support. Inclusion of frailty improved mortality prediction models.

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Evaluating frailty may complement APACHE II in estimating mortality in elderly patients admitted to the ICU after digestive surgery

Cited by 4 publications

References 28 publications

Efficacy and Safety of Dapagliflozin in Patients With Chronic Kidney Disease Across the Spectrum of Frailty

Efficacy and Safety of Dapagliflozin in Patients With Chronic Kidney Disease Across the Spectrum of Frailty

Closed thoracic drainage in elderly patients with chronic obstructive pulmonary disease complicated with spontaneous pneumothorax: A retrospective study

The impact of frailty on death, discharge destination and modelling accuracy in patients receiving organ support on the intensive care unit

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