Association of frailty with short-term outcomes, organ support and resource use in critically ill patients
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Frail patients are known to experience poor outcomes. Nevertheless, we know less about how frailty manifests itself in patients’ physiology during critical illness and how it affects resource use in intensive care units (ICU). We aimed to assess the association of frailty with short-term outcomes and organ support used by critically ill patients.
Retrospective analysis of prospective collected data from 93 ICUs in Brazil from 2014 to 2015. We assessed frailty using the modified frailty index (MFI). The primary outcome was in-hospital mortality. Secondary outcomes were discharge home without need for nursing care, ICU and hospital length of stay (LOS), and utilization of ICU organ support and transfusion. We used mixed logistic regression and competing risk models accounting for relevant confounders in outcome analyses.
The analysis consisted of 129,680 eligible patients. There were 40,779 (31.4%) non-frail (MFI = 0), 64,407 (49.7%) pre-frail (MFI = 1–2) and 24,494 (18.9%) frail (MFI ≥ 3) patients. After adjusted analysis, frailty was associated with higher in-hospital mortality (OR 2.42, 95% CI 1.89–3.08), particularly in patients admitted with lower SOFA scores. Frail patients were less likely to be discharged home (OR 0.36, 95% CI 0.54–0.79) and had higher hospital and ICU LOS than non-frail patients. Use of all forms of organ support (mechanical ventilation, non-invasive ventilation, vasopressors, dialysis and transfusions) were more common in frail patients and increased as MFI increased.
Frailty, as assessed by MFI, was associated with several patient-centered endpoints including not only survival, but also ICU LOS and organ support.
KeywordsFrailty Modified frailty index Organ support Resource use Outcomes Critical care
This study was supported by the National Council for Scientific and Technological Development (CNPq), Carlos Chagas Filho Foundation for Research Support of the State of Rio de Janeiro (FAPERJ) and by departmental funds from the D’Or Institute for Research and Education. We dedicate this work to the memory of Dr. Lígia Sarmet Farah Cunha Rabello, ORCHESTRA Study investigator, who recently passed away.
FGZ, TJI, EMV and MS participated in study conception, data interpretation, and drafting of the manuscript. FGZ performed the statistical analysis and produced the figures. FAB, JIFS and MS led data collection and cleaning. LUT, WNV, RC, TDC, CENM, MOM, GMM, TL, MAF, CEFF, CBC, BFM, MFAL, GVR, ARS, FAB and JIFS participated in data acquisition and revised the manuscript for important intellectual content. All authors approved the final copy of the manuscript.
Compliance with ethical standards
Conflicts of interest
Dr. Soares and Dr. Salluh are founders and equity shareholders of Epimed Solutions®, which commercializes the Epimed Monitor System®, a cloud-based software for ICU management and benchmarking. The other authors declare that they have no conflict of interest.
- 9.Mueller N, Murthy S, Tainter CR et al (2016) Can sarcopenia quantified by ultrasound of the rectus femoris muscle predict adverse outcome of surgical intensive care unit patients as well as frailty? A prospective, observational cohort study. Ann Surg 264:1116–1124. https://doi.org/10.1097/SLA.0000000000001546 CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Langlais E, Nesseler N, Le Pabic E et al (2018) Does the clinical frailty score improve the accuracy of the SOFA score in predicting hospital mortality in elderly critically ill patients? A prospective observational study. J Crit Care 46:67–72. https://doi.org/10.1016/j.jcrc.2018.04.012 CrossRefPubMedGoogle Scholar
- 15.Moreno RP, Metnitz PGH, Almeida E et al (2005) SAPS 3–from evaluation of the patient to evaluation of the intensive care unit. Part 2: development of a prognostic model for hospital mortality at ICU admission. Intensive Care Med 31:1345–1355. https://doi.org/10.1007/s00134-005-2763-5 CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Vincent JL, Moreno R, Takala J et al (1996) The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710CrossRefPubMedGoogle Scholar
- 27.R: the R project for statistical computing. https://www.r-project.org/. Accessed 8 Jun 2018