3 years ago

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

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

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).

Publisher URL: https://link.springer.com/article/10.1007/s00134-017-4940-8

DOI: 10.1007/s00134-017-4940-8

You might also like
Never Miss Important Research

Researcher is an app designed by academics, for academics. Create a personalised feed in two minutes.
Choose from over 15,000 academics journals covering ten research areas then let Researcher deliver you papers tailored to your interests each day.

  • Download from Google Play
  • Download from App Store
  • Download from AppInChina

Researcher displays publicly available abstracts and doesn’t host any full article content. If the content is open access, we will direct clicks from the abstracts to the publisher website and display the PDF copy on our platform. Clicks to view the full text will be directed to the publisher website, where only users with subscriptions or access through their institution are able to view the full article.