Mortality in Relation to Frailty in Patients Admitted to a Specialized Geriatric Intensive Care Unit

Abstract

Background.In older adults admitted to intensive care units (ICUs), frailty influences prognosis. We examined the relationship between the frailty index (FI) based on deficit accumulation and early and late survival.Methods.Older patients (≥65 years) admitted to a specialized geriatric ICU at the Liuhuaqiao Hospital, Guangzhou, China between July–December 2011 (n = 155; age 82.7±7.1 y; 87.1% men) were followed for 300 days. The FI was calculated as the proportion present of 52 health deficits. FI performance was compared with that of several prognostic scores.Results.The 90-day death rate was 38.7% (n = 60; 27 died within 30 days). The FI score was correlated with the Glasgow Coma Scale, Karnofsky Scale, Palliative Performance Scale, Acute Physiology Score—APACHE II and APACHE IV (r 2 = 0.52 to 0.72, p < 0.001). Patients who died within 30 days had higher mean FI scores (0.41±0.11) than those who survived to 300 days (0.22±0.11; F = 38.91, p < 0.001). Each 1% increase in the FI from the previous level was associated with an 11% increase in the 30-day mortality risk (95% CI: 7%–15%) adjusting for age, sex, and the prognostic scores. The FI discriminated patients who died in 30 days from those who survived with moderately high accuracy (AUC = 0.89±0.03). No one with an FI score >0.46 survived past 90 days.Conclusion.ICU survival was strongly associated with the level of frailty at admission. An FI based on health deficit accumulation may help improve critical care outcome prediction in older adults.

The status of intensive care medicine research and a future agenda for very old patients in the ICU

“…However, specific geriatric ICUs are scarce [17], and most VOPs are never visited by a geriatrician. Geriatricians' involvement is an advantage that recently has been found to provide a survival benefit in many other groups [18].…”

“…The effects of including a geriatrician in the early assessment and discharge of octogenarians. A prospective randomised trial (RCT) Inclusion of geriatric consultancy has proven valuable in other areas of medicine [17]. Only occasionally geriatricians are included in the care of ICU patients.…”

Fatores associados à fragilidade em idosos hospitalizados: uma revisão integrativa

“…On this, it was verified that higher values in the fragility scores can predict intra-hospital mortality. In the study by Zeng et al (2015), for example, each 1% increase in FI was associated with an 11% increase in 30-day mortality risk in elderly patients in the ICU. Likewise, as a high endpoint, the frail elderly evaluated also had a higher probability of mortality in three months (HUIJBERTS;BUURMAN;DE ROOIJ, 2016), in six months (JOOSTEN ET AL., 2014) and in twelve months (DENT;HOOGENDIJK, 2014).…”

“…Thus, in the study by Zeng et al (2015) the FI was calculated by means of a ratio of 52 health deficits, being compared to other prognostic scores in the Intensive Care Unit (ICU), such as the Glasgow Coma Scale and the Karnofsky Scale which, respectively, evaluate the level of consciousness and classify the patient according to the degree of functional deficiencies; Scale of Performance in Palliative Care, among others. Joseph et al (2014) used in their study the FI of 50 variables, which were obtained from the CSHA and included demographic data of the patient, social activity, daily life activities, nutritional status and general state of mood.…”

Using an Electronic Comprehensive Geriatric Assessment and Health Coaching to Prevent Frailty in Primary Care: The CARES Model

“…The underlying mechanisms of deficit accumulation suggest that there is a critical threshold of agerelated decline in multiple physiological systems, beyond which deficits start to accumulate, resulting in poor health [3,17]. The FI has been validated by researchers around the world with multiple studies, applied to population-based and clinical settings alike with diverse outcomes [18][19][20][21][22][23][24].…”