Frailty, delirium and hospital mortality of older adults admitted to intensive care: the Delirium (Deli) in ICU study

Sánchez, David Martí; Brennan, Kathleen; Sayfe, Masar Al; Shunker, Sharon-Ann; Bogdanoski, Tony; Hedges, Sonja; Hou, Yu Chin; Lynch, Joan; Hunt, Leanne; Alexandrou, Evan; Saxena, Manoj; Abel, Simon; Lakshmanan, Ramanathan; Bhonagiri, Deepak; Parr, Michael; Åneman, Anders; Chróinín, Danielle Ní; Hillman, Kenneth; Frost, Steven A.

doi:10.1186/s13054-020-03318-2

Cited by 60 publications

(54 citation statements)

References 20 publications

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“…In observational studies attempting to adjust for confounding by frailty or quantify its impact on outcomes, using the CFS score as either a categorical variable comprising all the original levels or a continuous variable while allowing for nonlinearities in the estimated effect of frailty on outcome is likely to lead to the least amount of residual confounding and improve inference compared to simpler approaches to modelling frailty such as dichotomisation or forced linearity [ 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study

Jung¹,

Beil²,

Rhodes³

et al. 2021

Crit Care

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Background The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context. Methods We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients ≥ 80 years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patient’s age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score. Results The median age in the sample of 7487 consecutive patients was 84 years (IQR 81–87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p < 0.001). The relationship between the CFS score and mortality was nonlinear (p < 0.01). Conclusion Knowledge about a patient’s frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided. Trial registration NCT03134807 (VIP1), NCT03370692 (VIP2)

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Section: Discussionmentioning

confidence: 99%

Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study

Jung¹,

Beil²,

Rhodes³

et al. 2021

Crit Care

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“…Dementia is a risk factor for presentation with traumatic injury due to increased risk of falls, 23 car crashes (although rates may fall in latter stages due to limited driving), 24 pedestrian injuries, 25 and elder abuse. 26 Frailty and delirium are intricately linked, 12 with common risk factors such as age and dementia. In our cohort, delirium was independently associated with LOS, whereas frailty was not.…”

Section: Discussionmentioning

confidence: 99%

Older trauma patients are at high risk of delirium, especially those with underlying dementia or baseline frailty

Chróinín

Francis

Wong

et al. 2021

Trauma Surg Acute Care Open

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BackgroundGiven the increasing numbers of older patients presenting with trauma, and the potential influence of delirium on outcomes, we sought to investigate the proportion of such patients who were diagnosed with delirium during their stay—and patient factors associated therewith—and the potential associations between delirium and hospital length of stay (LOS). We hypothesized that delirium would be common, associated with certain patient characteristics, and associated with long hospital LOS (highest quartile).MethodsWe conducted a retrospective observational cohort study of all trauma patients aged ≥65 years presenting in September to October 2019, interrogating medical records and the institutional trauma database. The primary outcome measure was occurrence of delirium.ResultsAmong 99 eligible patients, delirium was common, documented in 23% (23 of 99). On multivariable analysis, adjusting for age, frailty and history of dementia, frailty (OR 4.09, 95% CI 1.08 to 15.53, p=0.04) and dementia (OR 5.23, 95% CI 1.38 to 19.90, p=0.02) were independently associated with likelihood of delirium. Standardized assessment tools were underused, with only 34% (34 of 99) screened within 4 hours of arrival. On univariate logistic regression analysis, having an episode of delirium was associated with long LOS (highest quartile), OR of 5.29 (95% CI 1.92 to 14.56, p<0.001). In the final multivariable model, adjusting for any (non-delirium) in-hospital complication, delirium was independently associated with long LOS (≥16 days; OR 4.81, p=0.005).DiscussionIn this study, delirium was common. History of dementia and baseline frailty were associated with increased risk. Delirium was independently associated with long LOS. However, many patients did not undergo standardized screening at admission. Early identification and targeted management of older patients at risk of delirium may reduce incidence and improve care of this vulnerable cohort. These data are hypothesis generating, but support the need for initiatives which improve delirium care, acknowledging the complex interplay between frailty and other geriatric syndromes in the older trauma patients.Level of evidenceIII.

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“…In contrast, Pisani et al did not exclude ICU patients who died during their ICU stay or hospitalization [ 4 ]. The occurrence of delirium during hospitalization has been reported to increase hospital mortality among critically ill patients [ 37 ]; therefore, we excluded patients with ARDS who had more severe conditions, who might have been diagnosed with delirium, and died during hospitalization. The exclusion of the patients who died within 60 days of ARDS diagnosis may have influenced the results.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with delirium among survivors of acute respiratory distress syndrome: a nationwide cohort study

Park

Song

2021

BMC Pulm Med

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Background The prevalence of delirium, its associated factors, and its impact on long-term mortality among survivors of acute respiratory distress syndrome (ARDS) is unclear. Methods Since this was a population-based study, data were extracted from the National Health Insurance database in South Korea. All adults who were admitted to intensive care units with a diagnosis of ARDS between January 1, 2010, and December 31, 2019, and who survived for ≥ 60 days were included. The International Statistical Classification of Diseases and Related Health Problems, tenth revision code of delirium (F05) was used to extract delirium cases during hospitalization. Results A total of 6809 ARDS survivors were included in the analysis, and 319 patients (4.7%) were diagnosed with delirium during hospitalization. In the multivariable logistic regression analysis after covariate adjustment, male sex (odds ratio [OR] 1.60, 95% confidence interval [CI] 1.23, 2.08; P < 0.001), longer duration of hospitalization (OR 1.02, 95% CI 1.01, 1.03; P < 0.001), neuromuscular blockade use (OR 1.50, 95% CI 1.12, 2.01; P = 0.006), benzodiazepine (OR 1.55, 95% CI 1.13, 2.13; P = 0.007) and propofol (OR 1.48, 95% CI 1.01, 2.17; P = 0.046) continuous infusion, and concurrent depression (OR 1.31, 95% CI 1.01, 1.71; P = 0.044) were associated with a higher prevalence of delirium among ARDS survivors. In the multivariable Cox regression analysis after adjustment for covariates, the occurrence of delirium was not significantly associated with 1-year all-cause mortality, when compared to the other survivors who did not develop delirium (hazard ratio: 0.85, 95% CI 1.01, 1.71; P = 0.044). Conclusions In South Korea, 4.7% of ARDS survivors were diagnosed with delirium during hospitalization in South Korea. Some factors were potential risk factors for the development of delirium, but the occurrence of delirium might not affect 1-year all-cause mortality among ARDS survivors.

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Frailty, delirium and hospital mortality of older adults admitted to intensive care: the Delirium (Deli) in ICU study

Cited by 60 publications

References 20 publications

Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study

Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study

Older trauma patients are at high risk of delirium, especially those with underlying dementia or baseline frailty

Factors associated with delirium among survivors of acute respiratory distress syndrome: a nationwide cohort study

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