Intensive Care Medicine

, Volume 44, Issue 9, pp 1512–1520 | Cite as

Association of frailty with short-term outcomes, organ support and resource use in critically ill patients

  • Fernando G. Zampieri
  • Theodore J. Iwashyna
  • Elizabeth M. Viglianti
  • Leandro U. Taniguchi
  • William N. Viana
  • Roberto Costa
  • Thiago D. Corrêa
  • Carlos Eduardo N. Moreira
  • Marcelo O. Maia
  • Giulliana M. Moralez
  • Thiago Lisboa
  • Marcus A. Ferez
  • Carlos Eduardo F. Freitas
  • Clayton B. de Carvalho
  • Bruno F. Mazza
  • Mariza F. A. Lima
  • Grazielle V. Ramos
  • Aline R. Silva
  • Fernando A. Bozza
  • Jorge. I. F. Salluh
  • Marcio SoaresEmail author
  • for the ORCHESTRA Study Investigators



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.


Frailty 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.

Author contributors

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.

Supplementary material

134_2018_5342_MOESM1_ESM.pdf (526 kb)
Supplementary material 1 (PDF 526 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  • Fernando G. Zampieri
    • 1
    • 18
  • Theodore J. Iwashyna
    • 2
    • 3
  • Elizabeth M. Viglianti
    • 2
  • Leandro U. Taniguchi
    • 4
    • 5
  • William N. Viana
    • 6
  • Roberto Costa
    • 7
  • Thiago D. Corrêa
    • 8
  • Carlos Eduardo N. Moreira
    • 9
  • Marcelo O. Maia
    • 10
  • Giulliana M. Moralez
    • 11
  • Thiago Lisboa
    • 12
  • Marcus A. Ferez
    • 13
  • Carlos Eduardo F. Freitas
    • 14
  • Clayton B. de Carvalho
    • 15
  • Bruno F. Mazza
    • 16
  • Mariza F. A. Lima
    • 17
  • Grazielle V. Ramos
    • 11
  • Aline R. Silva
    • 11
  • Fernando A. Bozza
    • 11
    • 19
  • Jorge. I. F. Salluh
    • 11
  • Marcio Soares
    • 11
    Email author
  • for the ORCHESTRA Study Investigators
  1. 1.Research Institute, HCor-Hospital do CoraçãoSão PauloBrazil
  2. 2.Department of Internal MedicineUniversity of MichiganAnn ArborUSA
  3. 3.Veterans Affairs Center for Clinical Management ResearchHSR&D Center for ExcellenceAnn ArborUSA
  4. 4.ICU, Hospital Sírio LibanêsSão PauloBrazil
  5. 5.Emergency Medicine Discipline, Hospital das Clínicas HC-FMUSP, Universidade de São PauloSão PauloBrazil
  6. 6.ICUHospital Copa D’OrRio De JaneiroBrazil
  7. 7.ICUHospital Quinta D’OrRio De JaneiroBrazil
  8. 8.Adult ICUHospital Israelita Albert EinsteinSão PauloBrazil
  9. 9.ICUHospital Nove de JulhoSão PauloBrazil
  10. 10.ICUHospital Santa Luzia Rede D’Or São Luiz DFBrasíliaBrazil
  11. 11.Graduate Program in Translational Medicine and Department of Critical CareD’Or Institute for Research and EducationRio De JaneiroBrazil
  12. 12.ICU, Hospital Santa RitaSanta Casa de Misericórdia de Porto AlegrePorto AlegreBrazil
  13. 13.ICUHospital São FranciscoRibeirão PretoBrazil
  14. 14.ICUHospital Esperança OlindaOlindaBrazil
  15. 15.ICUHospital BrasíliaBrasíliaBrazil
  16. 16.ICUHospital SamaritanoSão PauloBrazil
  17. 17.ICUHospital EsperançaRecifeBrazil
  18. 18.ICUHospital Alemão Oswaldo CruzSão PauloBrazil
  19. 19.National Institute of Infectious Diseases Evandro ChagasOswaldo Cruz Foundation (FIOCRUZ)Rio de JaneiroBrazil

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