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

Fronczek, Jakub ; Polok, Kamil ; De Lange, Dylan W. ; Jung, Christian ; Beil, Michael ; Rhodes, Andrew ; Fjølner, Jesper ; Gorka, Jacek ; Andersen, Finn H and Artigas, Antonio , et al. (2021) In Critical Care 25(1).
Abstract
BackgroundThe 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.MethodsWe 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... (More)
BackgroundThe 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.MethodsWe 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.ResultsThe 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).ConclusionKnowledge 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. (Less)
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contributor
LU orcid and LU
author collaboration
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Critical Care
volume
25
issue
1
article number
231
publisher
BioMed Central (BMC)
external identifiers
  • scopus:85109183057
  • pmid:34210358
ISSN
1364-8535
DOI
10.1186/s13054-021-03632-3
language
English
LU publication?
yes
id
b02bce42-aa3a-456f-832f-51226a3da8a6
date added to LUP
2021-07-02 20:59:39
date last changed
2023-11-30 09:49:32
@article{b02bce42-aa3a-456f-832f-51226a3da8a6,
  abstract     = {{BackgroundThe 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.MethodsWe 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.ResultsThe 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 &lt; 0.001). The relationship between the CFS score and mortality was nonlinear (p &lt; 0.01).ConclusionKnowledge 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.}},
  author       = {{Fronczek, Jakub and Polok, Kamil and De Lange, Dylan W. and Jung, Christian and Beil, Michael and Rhodes, Andrew and Fjølner, Jesper and Gorka, Jacek and Andersen, Finn H and Artigas, Antonio and Cecconi, Maurizio and Christensen, Steffen and Joannidis, Michael and Leaver, Susannah and Marsh, Brian and Morandi, Alessandro and Moreno, Rui and Oeyen, Sandra and Agvald-Öhman, Sandra and Pinto, Bernardo Bollen and Schefold, Joerg C. and Valentin, Andreas and Walther, Sten and Watson, Ximena and Zafeiridis, Tilemachos and Sviri, Sigal and Van Heerden, Peter Vernon and Flaatten, Hans and Guidet, Bertrand and Szczeklik, Wojciech}},
  issn         = {{1364-8535}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{Critical Care}},
  title        = {{Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study}},
  url          = {{http://dx.doi.org/10.1186/s13054-021-03632-3}},
  doi          = {{10.1186/s13054-021-03632-3}},
  volume       = {{25}},
  year         = {{2021}},
}