How Does Frailty Affect ICU Outcome?
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Purpose of the Review
Frailty as a concept has been developed a lot during the last 25 years. From its start in geriatrics, its usefulness has also been demonstrated in most other clinical specialties including anesthesia, surgery, and intensive care. Several tools have been found useful to characterize frailty status: frailty phenotype, clinical frailty scale, or specific scores for surgical patients. The purpose of this review is to discuss how frailty interactive with acute critical illness and may alter ICU outcomes, particularly in the old patients.
Frailty has in many studies been found to have a substantial impact on most outcome parameters in ICU patients, mainly mortality, but also as non-mortality outcomes. Risk ratio for mortality in frail versus non-frail ICU patients is significantly increased.
Frailty affects several important body functions like the endocrine system and brain, muscular, and immune functions. In the ICU, these impaired body functions add to the traditional acute vital organ dysfunctions, well described in the ICU patient. This combination of reduced body function in patients that in addition develops a critical illness is the most likely cause of not only increased short-term but also long-term mortality found in frail ICU patients.
This review summarizes current tools to identify frailty and summarizes recent findings of the prognostic role of frailty in the ICU.
KeywordsFrailty Intensive care Outcome mortality Outcome non-mortality Assessment Elderly Cognition Sarcopenia Immunosenescence
Compliance with Ethical Standards
Conflict of Interest
Hans Flaatten declares that he has no conflict of interest.
Christian Jung has received research funding from Actelion Pharmaceuticals, Bayer Healthcare, Vifor Pharma, ZOLL Medical Corporation, Novartis, and Medicure, Inc.; has received compensation from Actelion Pharmaceuticals, Bayer Healthcare, Vifor Pharma, ZOLL Medical Corporation, Pfizer, Bristol-Myers Squibb, Abbott Vascular, Boston Scientific, Boehringer Ingelheim, Sanofi Aventis, Novartis, and Orion Pharma for service as a consultant; and has received non-financial support from Actelion Pharmaceuticals, Abbott Vascular, Novartis, and Orion Pharma.
Helene Vallet declares that she has no conflict of interest.
Bertrand Guidet declares that he has no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 5.•• Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56. A classical study and evaluation of the concept of frailty, making way for the phenotype model to describe frailty. CrossRefGoogle Scholar
- 6.•• Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, et al. A global clinical measure of fitness and frailty in elderly people. Can Med Assoc J. 2005;173(5):489–95. https://doi.org/10.1503/cmaj.050051. Results from a large Canadian study of frailty, resulting in the alternative description of frailty as cumulative deficits. CrossRefGoogle Scholar
- 12.• Muscedere J, Waters B, Varambally A, Bagshaw SM, Boyd JG, Maslove D, et al. The impact of frailty on intensive care unit outcomes: a systematic review and meta-analysis. Intensive Care Med. 2017;43(8):1105–22. https://doi.org/10.1007/s00134-017-4867-0. A large meta-analysis of frailty impact on outcomes in ICU patients. CrossRefGoogle Scholar
- 13.• Flaatten H, de Lange DW, Morandi A, Andersen FH, Artigas A, Bertolini G, et al. The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (≥ 80 years). Intensive Care Med. 2017;43(12):1820–8. https://doi.org/10.1007/s00134-017-4940-8. The largest prospective multi-national study on frailty in elderly ICU patients. CrossRefGoogle Scholar
- 14.The VIP2 study. https://www.vip2study.com/. Accessed 1 Feb 2019.
- 16.Guidet B, Flaatten H, Boumendil A, Morandi A, Andersen F, Artigas A, et al. Withholding or withdrawing of life sustaining therapy in very elderly patients (≥ 80 years) admitted to the intensive care unit. Intensive Care Med. 2018;44(7):1027–38. https://doi.org/10.1007/s00134-018-5196-7.CrossRefGoogle Scholar
- 18.Heyland DK, Garland A, Bagshaw SM, Cook D, Rockwood K, Stelfox HT, et al. Recovery after critical illness in patients aged 80 years or older: a multi-center prospective observational cohort study. Intensive Care Med. 2015;41(11):1911–20. https://doi.org/10.1007/s00134-015-4028-2.CrossRefGoogle Scholar
- 40.Vincent JL, de Mendonça A, Cantraine F, Moreno R, Takala J, Suter PM, et al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis-related problems” of the European Society of Intensive Care Medicine. Crit Care Med. 1998;26(11):1793–800.CrossRefGoogle Scholar