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Intensive Care Medicine

, Volume 43, Issue 12, pp 1820–1828 | Cite as

The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (≥ 80 years)

  • Hans Flaatten
  • Dylan W. De Lange
  • Alessandro Morandi
  • Finn H. Andersen
  • Antonio Artigas
  • Guido Bertolini
  • Ariane Boumendil
  • Maurizio Cecconi
  • Steffen Christensen
  • Loredana Faraldi
  • Jesper Fjølner
  • Christian Jung
  • Brian Marsh
  • Rui Moreno
  • Sandra Oeyen
  • Christina Agwald Öhman
  • Bernardo Bollen Pinto
  • Ivo W. Soliman
  • Wojciech Szczeklik
  • Andreas Valentin
  • Ximena Watson
  • Tilemachos Zaferidis
  • Bertrand Guidet
  • on behalf of the VIP1 study group
Original

Abstract

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.

Trial registration

ClinicalTrials.gov (ID: NCT03134807).

Keywords

Octogenarians Elderly ICU Mortality Frailty Severity of illness 

Notes

Acknowledgements

This study was endorsed by the ESICM. Free support for running the electronic database and eCRF was granted from the Department of Epidemiology, University of Aarhus, Denmark. The VIP1-study collaborators are listed in ESM Table 7.

Supplementary material

134_2017_4940_MOESM1_ESM.docx (645 kb)
Supplementary material 1 (DOCX 644 kb)
134_2017_4940_MOESM2_ESM.doc (487 kb)
Supplementary material 2 (DOC 487 kb)

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Copyright information

© Springer-Verlag GmbH Germany and ESICM 2017

Authors and Affiliations

  • Hans Flaatten
    • 1
    • 2
  • Dylan W. De Lange
    • 3
  • Alessandro Morandi
    • 4
    • 5
  • Finn H. Andersen
    • 6
    • 7
  • Antonio Artigas
    • 8
  • Guido Bertolini
    • 10
  • Ariane Boumendil
    • 11
  • Maurizio Cecconi
    • 12
  • Steffen Christensen
    • 9
  • Loredana Faraldi
    • 13
  • Jesper Fjølner
    • 9
  • Christian Jung
    • 14
  • Brian Marsh
    • 15
  • Rui Moreno
    • 16
  • Sandra Oeyen
    • 17
  • Christina Agwald Öhman
    • 18
  • Bernardo Bollen Pinto
    • 19
  • Ivo W. Soliman
    • 20
  • Wojciech Szczeklik
    • 21
  • Andreas Valentin
    • 22
  • Ximena Watson
    • 12
  • Tilemachos Zaferidis
    • 23
  • Bertrand Guidet
    • 24
    • 25
    • 26
  • on behalf of the VIP1 study group
  1. 1.Department of Clinical MedicineUniversity of BergenBergenNorway
  2. 2.Department of Anaesthesia and Intensive CareHaukeland University HospitalBergenNorway
  3. 3.Department of Intensive Care Medicine, University Medical CenterUniversity UtrechtUtrechtThe Netherlands
  4. 4.Department of Rehabilitation Hospital Ancelle di CremonaCremonaItaly
  5. 5.Geriatric Research GroupBresciaItaly
  6. 6.Department of Anaesthesia and Intensive CareÅlesund HospitalÅlesundNorway
  7. 7.Department of Circulation and Medical ImagingNTNUTrondheimNorway
  8. 8.Department of Intensive Care Medecine, CIBER Enfermedades RespiratoriasCorporacion Sanitaria Universitaria Parc Tauli, Autonomous University of BarcelonaSabadellSpain
  9. 9.Department of Anaesthesia and Intensive Care MedicineAarhus University HospitalAarhusDenmark
  10. 10.Laboratorio di Epidemiologia Clinica, Centro di Coordinamento GiViTI Dipar timento di Salute PubblicaIRCCS-Istituto di Ricerche Farmacologiche “Mario Negri”Ranica (Bergamo)Italy
  11. 11.Unite de Recherche en Epidemiologie Systemes d’Information et Mode lisation U707Institut national de la sante et de la recherche medicaleParisFrance
  12. 12.St George’s University HospitalLondonUK
  13. 13.Grande Ospedale Metropolitano NiguardaMilanItaly
  14. 14.Department of Cardiology, Pulmonology and AngiologyUniversity HospitalDüsseldorfGermany
  15. 15.Mater Misericordiae University HospitalDublinIreland
  16. 16.Unidade de Cuidados Intensivos Neurocríticos, Hospital de São José, Centro Hospitalar de Lisboa Central, Faculdade de Ciência Médicas de Lisboa, Nova Médical SchoolLisbonPortugal
  17. 17.Department of Intensive Care 1K12ICGhent University HospitalGhentBelgium
  18. 18.Karolinska University HospitalSolnaSweden
  19. 19.Geneva University HospitalsGenevaSwitzerland
  20. 20.Department of Intensive Care, University Medical CenterUniversity UtrechtUtrechtThe Netherlands
  21. 21.Intensive Care and Perioperative Medicine DivisionJagiellonian University Medical CollegeKrakówPoland
  22. 22.Kardinal Schwarzenberg HospitalSchwarzachAustria
  23. 23.Intensive Care Unit General Hospital of Larissa TsakalofLarissaGreece
  24. 24.Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicaleParisFrance
  25. 25.Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d’Epidémiologie et de Santé PubliqueParisFrance
  26. 26.INSERM, Institut Pierre Louis d’Epidémiologie et de Santé PubliqueParisFrance

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