Frailty, Acute Organ Dysfunction, and Increased Disability After Hospitalization in Older Adults Who Survive Critical Illness: A Prospective Cohort Study

Hope, Aluko A.; Law, Jammie; Nair, Rahul; Kim, Mimi; Gong, Michelle N.

doi:10.1177/0885066619881115

Cited by 8 publications

(11 citation statements)

References 41 publications

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“…Frail individuals admitted in ICU due to various illnesses were more likely to die in hospital, or within the next 6-12 months. 33,34 Moreover, pre-hospital frailty was associated with increased post-hospital disability, 35 with frail survivors being more likely to become functionally dependent or be admitted to nursing homes in the months following hospital discharge. 33,34 The lack of validation cohort is a limitation of our study, along with its retrospective character.…”

Section: Discussionmentioning

confidence: 99%

Clinical frailty, and not features of acute infection, is associated with late mortality in COVID‐19: a retrospective cohort study

Vlachogiannis

Baker

Georgiopoulos

et al. 2022

J cachexia sarcopenia muscle

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Background Coronavirus disease 2019 (COVID‐19) is associated with excess mortality after hospital discharge. Identification of patients at increased risk of death following hospital discharge is needed to guide clinical monitoring and early intervention. Herein, we aimed to identify predictors of early vs. late mortality in COVID‐19 patients. Methods A total of 471 patients with polymerase chain reaction‐confirmed COVID‐19 were followed up for 9 months [median (inter‐quartile range) of follow‐up time: 271 (14) days] after hospital admission. COVID‐19‐related signs and symptoms, laboratory features, co‐morbidities, Coronavirus Clinical Characterisation Consortium (4C) mortality and Clinical Frailty Scale (CFS) scores were analysed by logistic regression for association with early (28 day) vs. late mortality. Receiver operating characteristic (ROC) analysis was used to determine the discriminative value of 4C and CFS scores for early vs. late mortality. Results A total of 120 patients died within 28 days from hospital admission. Of the remaining 351 patients, 41 died within the next 8 months. Respiratory failure, systemic inflammation, and renal impairment were associated with early mortality, while active cancer and dementia were associated with late mortality, after adjustment for age and sex. 4C mortality score and CFS were associated with both early [odds ratio (OR) (95% confidence interval—CI): 4C : 1.34 (1.25–1.45); CFS : 1.49 (1.33–1.66)] and late [OR (95% CI): 4C : 1.23 (1.12–1.36); CFS : 2.04 (1.62–2.56)] mortality. After adjustment for CFS, the association between 4C and late mortality was lost. By ROC analysis, 4C mortality score was superior to CFS for 28 day mortality [area under the curve (AUC) (95% CI): 0.779 (0.732–0.825) vs. 0.723 (0.673–0.773), respectively; P = 0.039]. In contrast, CFS had higher predictive value for late mortality compared with 4C mortality score [AUC (95% CI): 0.830 (0.776–0.883) vs. 0.724 (0.650–0.798), respectively; P = 0.007]. Conclusions In our cohort, late mortality in COVID‐19 patients is more strongly associated with premorbid clinical frailty than with severity of the acute infection phase.

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Section: Discussionmentioning

confidence: 99%

Clinical frailty, and not features of acute infection, is associated with late mortality in COVID‐19: a retrospective cohort study

Vlachogiannis

Baker

Georgiopoulos

et al. 2022

J cachexia sarcopenia muscle

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“…Table 1 ). Most of the included studies ( n = 40, 70.2%) were prospective cohort studies [ 2 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 ], followed by retrospective cohort studies ( n = 13, 21.1%) [ 10 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 ].…”

Section: Resultsmentioning

confidence: 99%

“…For this purpose, Boumendil et al [22] used the Knauss classification [78] as based on physiological parameters. Some studies included cognition in their functional assessment, by using the Short Portable Mental Status Questionnaire (SPMSQ) [21] or Folstein's MMS [19], the cognitive score as component of Lawton-Brody IADL scale [23], the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) [10,34,46], the Clinical dementia rating scale (CDR) [47], or the Cognitive Performance Scale (CPS) [58]. Two studies added the nutritional status [27,47].…”

Section: Methods Of Frailty Assessment In the Critically Ill Andmentioning

confidence: 99%

Methods of Assessing Frailty in the Critically Ill: A Systematic Review of the Current Literature

et al. 2022

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Introduction: As new treatments have become established, more frail pre-ICU patients are being admitted to intensive care units (ICUs); this is creating new challenges to provide adequate care and to ensure that resources are allocated in an ethical and economical manner. This systematic review evaluates the current standard for assessing frailty on the ICU, including methods of assessment, time point of measurements, and cut-offs. Methods: A systematic search was conducted on MEDLINE, Clinical Trials, Cochrane Library, and Embase. Randomized and non-randomized controlled studies were included that evaluated diagnostic tools and ICU outcomes for frailty. Exclusion criteria were the following: studies without baseline assessment of frailty on ICU admission, studies in paediatric patients or pregnant women, and studies that targeted very narrow populations of ICU patients. Eligible articles were included until January 31, 2021. Methodological quality was assessed using the Newcastle-Ottawa Scale. No meta-analysis was performed, due to heterogeneity. Results: N = 57 articles (253,376 patients) were included using 19 different methods to assess frailty or a surrogate. Frailty on ICU admission was most frequently detected using the Clinical Frailty Scale (CFS) (n = 35, 60.3%), the Frailty Index (n = 5, 8.6%), and Fried’s frailty phenotype (n = 6, 10.3%). N = 22 (37.9%) studies assessed functional status. Cut-offs, time points, and manner of baseline assessment of frailty on ICU admission varied widely. Frailty on ICU admission was associated with short- and long-term mortality, functional and cognitive impairment, increased health care dependency, and impaired quality of life post-ICU discharge. Conclusions: Frailty assessment on the ICU is heterogeneous with respect to methods, cut-offs, and time points. The CFS may best reflect frailty in the ICU. Frailty assessments should be harmonized and performed routinely in the critically ill.

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“…Frailty after critically illness complicated by AKI may be challenging to predict given a "frail state" may be driven by heterogeneous social, cognitive and physical factors that are not readily apparent or measured at ICU admission. While frailty has increasingly been described in general ICU populations [5,13,[18][19][20][21][22][23][24], it has seldom been the focus among critically ill patients with severe AKI. A single-centre analysis of 317 critically ill patients enrolled in a prospective cohort study reported that AKI was associated with a worsened frailty status at 3 and 12 months after hospital discharge compared to those without AKI [9].…”

Section: Discussionmentioning

confidence: 99%

Frailty status among older critically ill patients with severe acute kidney injury

et al. 2021

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Background Frailty status among critically ill patients with acute kidney injury (AKI) is not well described despite its importance for prognostication and informed decision-making on life-sustaining therapies. In this study, we aim to describe the epidemiology of frailty in a cohort of older critically ill patients with severe AKI, the outcomes of patients with pre-existing frailty before AKI and the factors associated with a worsening frailty status among survivors. Methods This was a secondary analysis of a prospective multicentre observational study that enrolled older (age > 65 years) critically ill patients with AKI. The clinical frailty scale (CFS) score was captured at baseline, at 6 months and at 12 months among survivors. Frailty was defined as a CFS score of ≥ 5. Demographic, clinical and physiological variables associated with frailty as baseline were described. Multivariable Cox proportional hazard models were constructed to describe the association between frailty and 90-day mortality. Demographic and clinical factors associated with worsening frailty status at 6 months and 12 months were described using multivariable logistic regression analysis and multistate models. Results Among the 462 patients in our cohort, median (IQR) baseline CFS score was 4 (3–5), with 141 (31%) patients considered frail. Pre-existing frailty was associated with greater hazard of 90-day mortality (59% (n = 83) for frail vs. 31% (n = 100) for non-frail; adjusted hazards ratio [HR] 1.49; 95% CI 1.11–2.01, p = 0.008). At 6 months, 68 patients (28% of survivors) were frail. Of these, 57% (n = 39) were not classified as frail at baseline. Between 6 and 12 months of follow-up, 9 (4% of survivors) patients transitioned from a frail to a not frail status while 10 (4% of survivors) patients became frail and 11 (5% of survivors) patients died. In multivariable analysis, age was independently associated with worsening CFS score from baseline to 6 months (adjusted odds ratio [OR] 1.08; 95% CI 1.03–1.13, p = 0.003). Conclusions Pre-existing frailty is an independent risk factor for mortality among older critically ill patients with severe AKI. A substantial proportion of survivors experience declining function and worsened frailty status within one year.

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Frailty, Acute Organ Dysfunction, and Increased Disability After Hospitalization in Older Adults Who Survive Critical Illness: A Prospective Cohort Study

Cited by 8 publications

References 41 publications

Clinical frailty, and not features of acute infection, is associated with late mortality in COVID‐19: a retrospective cohort study

Clinical frailty, and not features of acute infection, is associated with late mortality in COVID‐19: a retrospective cohort study

Methods of Assessing Frailty in the Critically Ill: A Systematic Review of the Current Literature

Frailty status among older critically ill patients with severe acute kidney injury

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