Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study (original) (raw)
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Intensive Care Medicine, 2014
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.
Annals of Medical Research, 2018
Aim: Frailty can be defined as reduced resistance capacity against the environmental stresses due to a cumulative decline in the physiological reserves of the subject. Clinical Frailty Scale (CFS) can be used to measure frailty. We aimed to calculate the prevalence of frailty in patients admitted to intensive care unit (ICU) and analyze some general features of those patients. Material and Methods: The study was conducted in general ICUs of a state hospital. Patients who were admitted between January 2016 and March 2018 were analyzed retrospectively. Demographic characteristics, "Clinical Frailty Scale" (CFS) score, clinical data and other patient results were recorded. Subsequently, patients were divided into two groups as frail (CFS≥5) and non-frail (CFS<5) and then statistically compared. Results: A total of 1139 patients were included in the study. The frailty rate of patients aged 50 years and over was 54.7%. The median age of the frail group was significantly higher (78 vs 69 year; p<0,0001). APACHE II, mechanical ventilation rate, and length of ICU stay were significantly higher in the frail group (25 vs 22; p<0,0001 ve 69,8% vs 52%; p<0,0001 ve 14 vs 11days; p=0,007, respectively). Intensive care costs were also significantly higher in the frail group (1540 vs 1242 US Dollar; p=0,019). The total mortality rate was 39.9%; in frail group. This rate was significantly higher than non-frail group (48,6% vs 29,3%; p<0,0001). Frailty (CFS≥5) were shown to be an independent risk factor for mortality (p=0.014, OR 1.464, 95% CI 1.081-1.982) Conclusion: We recommend the routine use of CFS, which is especially useful in predicting frailty and mortality in intensive care unit.
Intensive Care Medicine
Purpose: Very old critical ill patients are a rapid expanding group in the ICU. Indications for admission, triage criteria and level of care are frequently discussed for such patients. However, most relevant outcome studies in this group frequently find an increased mortality and a reduced quality of life in survivors. The main objective was to study the impact of frailty compared with other variables with regards to short-term outcome in the very old ICU population. Methods: A transnational prospective cohort study from October 2016 to May 2017 with 30 days follow-up was set up by the European Society of Intensive Care Medicine. In total 311 ICUs from 21 European countries participated. The ICUs included the first consecutive 20 very old (≥ 80 years) patients admitted to the ICU within a 3-month inclusion period. Frailty, SOFA score and therapeutic procedures were registered, in addition to limitations of care. For measurement of frailty the Clinical Frailty Scale was used at ICU admission. The main outcomes were ICU and 30-day mortality and survival at 30 days. Results: A total of 5021 patients with a median age of 84 years (IQR 81-86 years) were included in the final analysis, 2404 (47.9%) were women. Admission was classified as acute in 4215 (83.9%) of the patients. Overall ICU and 30-day mortality rates were 22.1% and 32.6%. During ICU stay 23.8% of the patients did not receive specific ICU procedures: ventilation, vasoactive drugs or renal replacement therapy. Frailty (values ≥ 5) was found in 43.1% and was independently related to 30-day survival (HR 1.54; 95% CI 1.38-1.73) for frail versus non-frail. Conclusions: Among very old patients (≥ 80 years) admitted to the ICU, the consecutive classes in Clinical Frailty Scale were inversely associated with short-term survival. The scale had a very low number of missing data. These findings provide support to add frailty to the clinical assessment in this patient group.
Journal of Critical Care, 2014
To determine whether frailty can be measured within 4 days prior to hospital discharge in older intensive care unit (ICU) survivors of respiratory failure and whether it is associated with post-discharge disability and mortality. Materials and Methods: We performed a single-center prospective cohort study of 22 medical ICU survivors age 65 years or older who had received noninvasive or invasive mechanical ventilation for at least 24 hours. Frailty was defined as a score of ≥3 using Fried's 5-point scale. We measured disability with the Katz Activities of Daily Living. We estimated unadjusted associations between Fried's frailty score and incident disability at 1-month and 6-month mortality using Cox proportional hazard models. Results: The mean (SD) age was 77 (9) years, mean Acute Physiology and Chronic Health Evaluation II score was 27 (9.7), mean frailty score was 3.4 (1.3), and 18 (82%) were frail. Nine subjects (41%) died within 6 months, and all were frail. Each 1-point increase in frailty score was associated with a 90% increased rate of incident disability at 1-month (rate ratio: 1.9, 95% CI 0.7-4.9) and a threefold increase in 6-month mortality (rate ratio: 3.0, 95% CI 1.4-6.3). Conclusions: Frailty can be measured in older ICU survivors near hospital discharge and is associated with 6-month mortality in unadjusted analysis. Larger studies to determine if frailty independently predicts outcomes are warranted.
Prevalence of Frailty in ICU and its Impact on Patients’ Outcomes
Indian Journal of Critical Care Medicine
Introduction: Frailty describes a state or syndrome of reduced physical, physiologic, and cognitive reserve that increases vulnerability to acute illness. To study the prevalence of frailty in critically ill patients and find its association with resource utilization and short-term intensive care unit (ICU) outcomes. Material and methods: This was a prospective observational study. All adult patients ≥50 years admitted to the ICU were included and frailty was assessed by clinical frailty score (CFS). Data were collected on demography, coexisting illness, CFS, Acute Physiology and Chronic Health Evaluation II (APACHE-II), and Sequential Organ Failure Assessment Score (SOFA) scores. Patients were followed for 30 days. Outcome data were collected on organ supports provided, duration of ICU and hospital length of stay (LOS), and ICU and 30-day mortality. Results: 137 patients were enrolled in the study. The prevalence of frailty was 38.6%. Frail patients were older and had a more comorbid illness. APACHE-II and SOFA scores were 22.1 ± 7.0 and 7.2 ± 3.29, significantly higher in frail patients, respectively. There was a trend towards higher requirement of organ supports in frail patients. Median ICU and hospital LOS were 8 vs 6 and 20 vs 12 (frail vs nonfrail) days, respectively (p < 0.05). Intensive care unit mortality in frail and nonfrail patients were 28.3% and 23.8%, respectively (p = 0.56). Thirty-day mortality in frail patients was 49%, significantly higher compared with nonfrail patients (28.5%). Conclusion: The prevalence of frailty in ICU patients was high. Frail patients were quite ill on ICU admission, and they had a prolonged ICU and hospital LOS. Increasing frailty score was associated with higher mortality at 30 days.
Reliability of the Clinical Frailty Scale in very elderly ICU patients: a prospective European study
Annals of Intensive Care, 2021
Purpose Frailty is a valuable predictor for outcome in elderly ICU patients, and has been suggested to be used in various decision-making processes prior to and during an ICU admission. There are many instruments developed to assess frailty, but few of them can be used in emergency situations. In this setting the clinical frailty scale (CFS) is frequently used. The present study is a sub-study within a larger outcome study of elderly ICU patients in Europe (the VIP-2 study) in order to document the reliability of the CFS. Materials and methods From the VIP-2 study, 129 ICUs in 20 countries participated in this sub-study. The patients were acute admissions ≥ 80 years of age and frailty was assessed at admission by two independent observers using the CFS. Information was obtained from the patient, if not feasible, from the family/caregivers or from hospital files. The profession of the rater and source of data were recorded along with the score. Interrater variability was calculated u...
BMC geriatrics, 2018
In intensive care units (ICU) octogenarians become a routine patients group with aggravated therapeutic and diagnostic decision-making. Due to increased mortality and a reduced quality of life in this high-risk population, medical decision-making a fortiori requires an optimum of risk stratification. Recently, the VIP-1 trial prospectively observed that the clinical frailty scale (CFS) performed well in ICU patients in overall-survival and short-term outcome prediction. However, it is known that healthcare systems differ in the 21 countries contributing to the VIP-1 trial. Hence, our main focus was to investigate whether the CFS is usable for risk stratification in octogenarians admitted to diversified and high tech German ICUs. This multicentre prospective cohort study analyses very old patients admitted to 20 German ICUs as a sub-analysis of the VIP-1 trial. Three hundred and eight patients of 80 years of age or older admitted consecutively to participating ICUs. CFS, cause of adm...
Frailty increases mortality among patients ≥ 80 years old treated in Polish ICUs
Anestezjologia Intensywna Terapia
Background: The increasing population of very old intensive care patients (VIPs) is a major challenge currently faced by clinicians and policymakers. Reliable indicators of VIPs' prognosis and appropriateness of their admission to the intensive care unit (ICU) are urgently needed. Methods: This is a report from the Polish sample of the VIP1 multicentre cohort study (NCT03134807). Patients ≥ 80 years of age admitted to the ICU were included in the study. Information on the type and reason for admission, demographics, utilisation of ICU procedures, ICU length of stay, organ dysfunction and the decision to apply end-of-life care was collected. The primary objective was to investigate the impact of frailty syndrome on ICU and 30-day survival of VIPs. Frailty was assessed with the Clinical Frailty Scale (≥ 5 points on a scale of 1-9). Results: We enrolled 272 participants with a median age of 84 (81-87) years. Frailty was diagnosed in 170 (62.5%) patients. The ICU and 30-day survival rates were equal to 54.6% and 47.3% respectively. Three variables were found to significantly increase the odds of death in the ICU in a multiple logistic regression model, namely:
Canadian Medical Association Journal, 2014
F railty is a term widely used to describe a multidimensional syndrome characterized by the loss of physiologic and cognitive reserves that gives rise to heightened vulnerability to adverse outcomes. 1,2 Adverse events associated with frailty include incident falls, susceptibility to acute illness, perioperative complications, unplanned hospital admissions, disability, need for institutional care, and death. 3−10 Frailty has substantial implications for quality of life, functional autonomy and health services utilization, but it has not been evaluated in critically ill patients. The development of critical illness may lead to frailty in vulnerable patients. Critical illness may also be a key factor impeding recovery and functional autonomy in those already considered to be frail. 11 We hypothesized that frailty would identify vulnerable patients who are less likely to tolerate critical illness, who are more susceptible to complications and death, and who are less likely to fully recover after critical illness over the short or long term. We further hypothesized that this information would translate into more accurate prognostication, which might improve decision-making for frail patients and their families. To test these hypotheses, we performed a prospective multi-centre study in an unselected cohort of critically ill patients. Methods Study design and population This was a multicentre prospective cohort study. The study population comprised adults admitted to 1 of 6 participating intensive care units (ICUs) between Feb. 1, 2010, and July 31, 2011. The ICUs were located in 2 tertiary care academic hospitals and 4 community hospitals in the province of