Prevalence and impact of frailty on mortality in elderly ICU patients: a prospective, multicenter, observational study

Abstract

Conflict of interest statement. PLM, AR, EC, MSM, OM, GLG, DS, CC, FF, YM, and PS declare that they have no conflicts of interest. SL has received consulting fees from Viforpharma. KA has received lecturing and consulting fees from Braun, Astellas, and Fresenius. AbstractPurpose: Frailty is a recent concept used for evaluating elderly individuals. Our study determined the prevalence of frailty in intensive care unit (ICU) patients and its impact on the rate of mortality. Methods:A multicenter, prospective, observational study performed in four ICUs in France included 196 patients aged ≥65 years hospitalized for >24 hours during a 6-month study period. Frailty was determined using the frailty phenotype (FP) and the clinical frailty score (CFS). The patients were separated as follows: FP score <3 or ≥3 and CFS < 5 or ≥ 5.Results: Frailty was observed in 41% and 23% of patients based on a FP score ≥3 and a CFS ≥5, respectively. At admission to the ICU, the Simplified Acute Physiology Score II (SAPS II) and Sequential Organ Failure Assessment (SOFA) scores did not differ between the frail and nonfrail patients. In the multivariate analysis, the risk factors for ICU mortality were FP score ≥3 (hazard ratio [HR], 3.3; 95% confidence interval [CI], 1.6-6.6; p<0.001), male gender (HR, 2.4; 95% CI, 1.1-5.3; p=0.026), cardiac arrest before admission (HR, 2.8; 95% CI, 1.1-7.4; p=0.036), SAPS II score ≥ 46 (HR, 2.6; 95% CI, 1.2-5.3; p=0.011), and brain injury before admission (HR, 3.5; 95% CI, 1.6-7.7; p=0.002). The risk factors for 6-month mortality were a CFS ≥5 (HR, 2.4; 95% CI, 1.49-3.87; p<0.001) and a SOFA score ≥7 (HR, 2.2; 95% CI, 1.35-3.64; p=0.002). An increased CFS was associated with significant incremental hospital and 6-month mortalities. Conclusions:Frailty is a frequent occurrence and is independently associated with increased ICU and 6-month mortalities.Notably, the CFS predicts outcomes more effectively than the commonly used ICU illness scores.

Scratching the surface: the burden of frailty in critical care

“…The present work by Le Maguet and colleagues confirms and perhaps extends our findings regarding the potential prognostic value of a pre-existing frail state in the course and outcome of critical illness [1]. The author performed a 6-month prospective, observational cohort study of 196 critically ill patients aged at least 65 years old admitted to ICU for at least 24 h at four academic hospitals in France to describe the prevalence of frailty and its association with mortality.…”

“…In this issue of Intensive Care Medicine, Le Maguet and colleagues explore the geriatric syndrome of frailty in the context of critical illness [1]. The term ''frailty'' is widely used to describe an age-associated state that is characterized by a multidimensional accumulated decline of physiologic and cognitive reserves, giving rise to increased vulnerability to adverse events [2].…”

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

“…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.…”

“…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.…”

What were you able to do in your daily life? Performance status for the critically ill patient

“…Frailty is another condition affecting PS that leads to increased vulnerability to adverse events, like ICU admission [2]. Frailty has been associated with ICU mortality [3], hospital mortality, readmissions, institutionalization [4], and poor long-term quality of life [5]. The same factors that contribute to frailty may affect PS either directly or indirectly ( Fig.…”