Both the Clinical Frailty Scale and Frailty Index can be used for frailty ascertainment on admission and during recovery from critical illness although the Frailty Index identifies more patients as frail. | |
Frailty is associated with severity dependent mortality increases using both the Clinical Frailty Scale and Frailty Index. | |
Processes of care were similar between frail and non-frail patients with the exception of decreased mobility and more frequent delirium in frail patients. | |
In survivors, frailty during recovery is dynamic with many patients transitioning to increased frailty states. Further research on how to improve the recovery of critically ill frail patients is required. |
Introduction
Methods
Data collection
Frailty
Outcomes and statistical analysis
Sample size
Results
Frailty prevalence
Frailty trajectory
Clinical frailty scale | ICU admission n = 687 | Hospital discharge n = 451 | 6 months n = 366 |
---|---|---|---|
CFS aggregate (mean ± SD) | 3.9 ± 1.7 | 4.8 ± 1.7 | 4 ± 1.8 |
CFS 1–3, n (%) | 320 (46.6) | 116 (25.7) | 162 (44.3) |
CFS 4, n (%) | 162 (23.6) | 89 (19.7) | 79 (22.6) |
CFS ≥ 5, n (%) | 205 (29.8)* | 246 (54.6)& | 125 (34.1)# |
Frailty Index | ICU admission n = 684 | Hospital discharge n = 446 | 6 months n = 364 |
---|---|---|---|
FI aggregate (mean ± SD) | 0.2 ± 0.1 | 0.3 ± 0.1 | 0.2 ± 0.1 |
FI < 0.1, n (%) | 183 (26.8) | 46 (10.3) | 108 (29.7) |
FI ≥ 0.1 and < 0.2, n (%) | 194 (28.4) | 97 (21.8) | 101 (27.8) |
FI ≥ 0.2, n (%) | 307 (44.8) * | 303 (67.9)& | 155 (42.6)# |
Processes of care
Non-frail CFS < 5 n = 482 | Frail CFS ≥ 5 n = 205 | p value | Non-frail FI < 0.2 n = 377 | Frail FI ≥ 0.2 n = 307 | p value | |
---|---|---|---|---|---|---|
Maximum SOFA, mean ± SD | 9.6 ± 4.1 | 10.4 ± 4.1 | 0.03 | 9.5 ± 4.0 | 10.2 ± 4.2 | 0.02 |
SOFA during ICU, mean ± SD | 6.2 ± 3.3 | 7.0 ± 3.6 | 0.007 | 6.2 ± 3.2 | 6.9 ± 3.6 | 0.01 |
Positive culture ≤ 48 h after ICU admit, n (%) | 146 (30) | 94 (46) | < 0.0001 | 107 (28) | 132 (43) | < 0.0001 |
Positive culture > 48 h. after ICU admit, n (%) | 163 (36) | 68 (35) | 0.87 | 124 (35) | 107 (37) | 0.61 |
Antibiotic free days, median (IQR) | 21 (11, 4) | 19 (0, 24] | 0.002 | 21 (13, 25) | 19 (0, 23) | < 0.0001 |
Benzodiazepine use, n (%) | 236 (49) | 92 (45) | 0.33 | 179 (47) | 148 (48) | 0.85 |
Antipsychotic use, n (%) | 122 (25) | 65 (32) | 0.08 | 94 (25) | 92 (30) | 0.14 |
Opioid use, n (%) | 422 (88) | 177 (86) | 0.66 | 329 (87) | 268 (87) | 0.99 |
Ever delirious, n (%) | 231 (57) | 107 (60) | 0.43 | 166 (54) | 170 (62) | 0.042 |
Percent prescribed calories* received, [n] median (IQR) | [425] 42.5 (0.1, 69.3) | [187] 39.9 (2.4, 71.4) | 0.52 | [339] 39.8 (0.1–68.5) | [270] 41.3 (4.4–71.9) | 0.09 |
Percent prescribed protein* received, [n] median (IQR) | [426] 40.3 (0.0, 67.8) | [186] 42.7 (2.2–69.1) | 0.53 | [339] 38.0 (0.0–66.7] | [270] 43.4 (3.3–69.8) | 0.19 |
ICU Mobility Scale (max), median (IQR) | 3 (1–6) | 2 (0–5) | < 0.0001 | 4 (1–6) | 2 (0- 5) | < 0.0001 |
ICU Mobility Scale (final), median (IQR) | 2 (0–5) | 1 (0- 4) | < 0.0001 | 3 (0- 5) | 1 (0–4) | < 0.0001 |
PT assessment, n (%) | 327 (68) | 135 (66) | 0.62 | 255 (68) | 206 (67) | 0.85 |
Outcomes
Hospital outcomes | Non-frail CFS < 5 (n = 482) | Frail CFS ≥ 5 (n = 205) | p value | Non-frail FI < 0.2 (n = 377) | Frail FI ≥ 0.2 (n = 207) | p value |
---|---|---|---|---|---|---|
ICU LOS, days (median, IQR) | 8 (6, 15) | 8 (5, 17) | 0.95 | 8 (6, 15) | 9 (6, 17) | 0.38 |
ICU free days, (median, IQR) | 18 (4, 22) | 14 (0, 22] | 0.007 | 15 (0 to 21) | 17 (0, 22) | 0.0003 |
MV duration, days (median, IQR) | 6 (3, 11) | 6 (3, 13) | 0.56 | 6 (3, 13) | 6 (3, 12) | 0.45 |
Vent free days, (median, IQR) | 21 (8, 25) | 18 (0, 24) | 0.001 | 19 (0, 24) | 21 (1, 25) | 0.0004 |
Hosp. LOS, days (median, IQR) | 19 (11, 33) | 19 (9, 41) | 0.57 | 18 (10, 32) | 21 (11, 40) | 0.06 |
Death in ICU, n (%) | 69 (14) | 54 (26) | 0.0002 | 49 (13) | 73 (24) | 0.0002 |
Death in hospital, n (%) | 92 (19) | 72 (35) | < 0.0001 | 66 (18) | 97 (32) | < 0.0001 |
*Discharge home (with or without support), n (%) | 216 (52) | 58 (38) | 0.003 | 174 (53) | 98 (42) | 0.01 |
Six Month Outcomes | ||||||
---|---|---|---|---|---|---|
Death, n (%) | 126 (26) | 105 (51) | < 0.001 | 90 (24) | 140 (46) | < 0.0001 |
&Living at home (with or without support), [n] n (%) | [325] 257 (79) | [122] 56 (46) | < 0.001 | [262] 213 (81) | [183] 98 (54) | < 0.001 |
&Katz ADL, [n] mean ± SD | [268] 5.1 ± 1.3 | [79] 3.2 ± 2 | < 0.001 | [218] 5.3 ± 1.2 | [127] 3.7 ± 1.9 | < 0.001 |
&PPS, [n] mean ± SD | [280] 75.8 ± 18.6 | [80] 55.3 ± 16.7 | < 0.001 | [227] 78 ± 18.3 | [131] 59.4 ± 17.4 | < 0.001 |
&Alive and PPS < 10% of ICU admission, [n] n (%) | [312] 79 (25) | [113] 20 (18) | 0.1 | [249] 67 (27) | [174] 31 (18) | 0.03 |
&EQ5D5L utility, [n] mean ± SD | [272] 0.8 ± 0.2 | [89] 0.6 ± 0.2 | < 0.001 | [222] 0.8 ± 0.2 | [127] 0.6 ± 0.3 | < 0.001 |
Hospital Discharge CFS < 5 (n = 205) | Hospital Discharge CFS ≥ 5 (n = 246) | p value | Hospital Discharge FI < 0.2 (n = 141) | Hospital Discharge FI ≥ 0.2 (n = 305) | p value | |
---|---|---|---|---|---|---|
Mortality, n (%) | 11 (5) | 38 (15) | 0.001 | 8 (6) | 40 (13) | 0.017 |
&,*Hospitalizations since discharge, [n] mean ± SD | [39] 1.8 ± 1.3 | [65] 1.6 ± 1.2 | 0.67 | [23] 2 ± 1.3 | [81] 1.6 ± 1.2 | 0.071 |
&*Physician visits, [n] median (IQR) | [106] 2 (1, 3) | [104] 2 (1, 3) | 0.59 | [67] 2 (1, 3) | [141] 2 (1, 3) | 0.33 |
Home (with and without support), n (%) | 153 (75) | 138 (56) | < 0.0001 | 104 (74) | 185 (61) | 0.0002 |
&Katz ADL, [n] mean ± SD | [154] 5.3 ± 1.1 | [165] 4.2 ± 1.9 | < 0.0001 | [102] 5.7 ± 0.6 | [214] 4.3 ± 1.8 | < 0.0001 |
&PPS, [n] mean ± SD | [161] 80.5 ± 17.1 | [170] 63.5 ± 19.1 | < 0.0001 | [106] 83.5 ± 16 | [222] 66.4 ± 19.1 | < 0.0001 |
&Alive
and PPS within 10% of ICU admission, [n] n (%) | [171] 52 (30) | [208] 41 (20) | 0.02 | [113] 43 (38) | [262] 47 (18) | < 0.0001 |
&EQ5D5L [n] mean ± SD | [159] 0.8 ± 0.2 | [165] 0.7 ± 0.2 | < 0.0001 | [105] 0.9 ± 0.2 | [217] 0.7 ± 0.2 | < 0.0001 |