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

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Abstract

Purpose

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 h 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 on the basis of an 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.

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Acknowledgments

We thank Aurore Hoarau and Veronique Sebille (EA 4275 Biostatistique, Recherche Clinique et Mesures Subjectives en Santé, Université of Nantes Faculté de Médecine, Nantes Cedex 1, France) for their help in performing the statistical analysis and Kenneth Rockwood for providing constructive comments.

Conflicts of interest

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.

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Correspondence to Philippe Seguin.

Additional information

Take-home message: Frailty, a recent concept for evaluation of elderly, may help physicians in their decision-making. We showed that frailty was frequent in ICUs patients aged 65 or more, independently associated with ICU and 6 months mortalities, and better predicts outcome than usual ICU illness scores.

A related editorial is available at doi:10.1007/s00134-014-3246-3.

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Le Maguet, P., Roquilly, A., Lasocki, S. et al. Prevalence and impact of frailty on mortality in elderly ICU patients: a prospective, multicenter, observational study. Intensive Care Med 40, 674–682 (2014). https://doi.org/10.1007/s00134-014-3253-4

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