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The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (≥ 80 years)

Flaatten, Hans ; De Lange, Dylan W. ; Morandi, Alessandro ; Andersen, Finn H. ; Artigas, Antonio ; Bertolini, Guido ; Boumendil, Ariane ; Cecconi, Maurizio ; Christensen, Steffen and Faraldi, Loredana , et al. (2017) In Intensive Care Medicine 43(12). p.1820-1828
Abstract

Purpose: Very old critical ill patients are a rapid expanding group in the ICU. Indications for admission, triage criteria and level of care are frequently discussed for such patients. However, most relevant outcome studies in this group frequently find an increased mortality and a reduced quality of life in survivors. The main objective was to study the impact of frailty compared with other variables with regards to short-term outcome in the very old ICU population. Methods: A transnational prospective cohort study from October 2016 to May 2017 with 30 days follow-up was set up by the European Society of Intensive Care Medicine. In total 311 ICUs from 21 European countries participated. The ICUs included the first consecutive 20 very... (More)

Purpose: Very old critical ill patients are a rapid expanding group in the ICU. Indications for admission, triage criteria and level of care are frequently discussed for such patients. However, most relevant outcome studies in this group frequently find an increased mortality and a reduced quality of life in survivors. The main objective was to study the impact of frailty compared with other variables with regards to short-term outcome in the very old ICU population. Methods: A transnational prospective cohort study from October 2016 to May 2017 with 30 days follow-up was set up by the European Society of Intensive Care Medicine. In total 311 ICUs from 21 European countries participated. The ICUs included the first consecutive 20 very old (≥ 80 years) patients admitted to the ICU within a 3-month inclusion period. Frailty, SOFA score and therapeutic procedures were registered, in addition to limitations of care. For measurement of frailty the Clinical Frailty Scale was used at ICU admission. The main outcomes were ICU and 30-day mortality and survival at 30 days. Results: A total of 5021 patients with a median age of 84 years (IQR 81–86 years) were included in the final analysis, 2404 (47.9%) were women. Admission was classified as acute in 4215 (83.9%) of the patients. Overall ICU and 30-day mortality rates were 22.1% and 32.6%. During ICU stay 23.8% of the patients did not receive specific ICU procedures: ventilation, vasoactive drugs or renal replacement therapy. Frailty (values ≥ 5) was found in 43.1% and was independently related to 30-day survival (HR 1.54; 95% CI 1.38–1.73) for frail versus non-frail. Conclusions: Among very old patients (≥ 80 years) admitted to the ICU, the consecutive classes in Clinical Frailty Scale were inversely associated with short-term survival. The scale had a very low number of missing data. These findings provide support to add frailty to the clinical assessment in this patient group. Trial registration: ClinicalTrials.gov (ID: NCT03134807).

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Contribution to journal
publication status
published
subject
keywords
Elderly, Frailty, ICU, Mortality, Octogenarians, Severity of illness
in
Intensive Care Medicine
volume
43
issue
12
pages
9 pages
publisher
Springer
external identifiers
  • pmid:28936626
  • scopus:85029721289
ISSN
0342-4642
DOI
10.1007/s00134-017-4940-8
language
English
LU publication?
no
id
c7525a4f-48ad-488a-94d6-fffd872754d5
date added to LUP
2021-01-23 19:38:34
date last changed
2024-06-14 08:58:30
@article{c7525a4f-48ad-488a-94d6-fffd872754d5,
  abstract     = {{<p>Purpose: Very old critical ill patients are a rapid expanding group in the ICU. Indications for admission, triage criteria and level of care are frequently discussed for such patients. However, most relevant outcome studies in this group frequently find an increased mortality and a reduced quality of life in survivors. The main objective was to study the impact of frailty compared with other variables with regards to short-term outcome in the very old ICU population. Methods: A transnational prospective cohort study from October 2016 to May 2017 with 30 days follow-up was set up by the European Society of Intensive Care Medicine. In total 311 ICUs from 21 European countries participated. The ICUs included the first consecutive 20 very old (≥ 80 years) patients admitted to the ICU within a 3-month inclusion period. Frailty, SOFA score and therapeutic procedures were registered, in addition to limitations of care. For measurement of frailty the Clinical Frailty Scale was used at ICU admission. The main outcomes were ICU and 30-day mortality and survival at 30 days. Results: A total of 5021 patients with a median age of 84 years (IQR 81–86 years) were included in the final analysis, 2404 (47.9%) were women. Admission was classified as acute in 4215 (83.9%) of the patients. Overall ICU and 30-day mortality rates were 22.1% and 32.6%. During ICU stay 23.8% of the patients did not receive specific ICU procedures: ventilation, vasoactive drugs or renal replacement therapy. Frailty (values ≥ 5) was found in 43.1% and was independently related to 30-day survival (HR 1.54; 95% CI 1.38–1.73) for frail versus non-frail. Conclusions: Among very old patients (≥ 80 years) admitted to the ICU, the consecutive classes in Clinical Frailty Scale were inversely associated with short-term survival. The scale had a very low number of missing data. These findings provide support to add frailty to the clinical assessment in this patient group. Trial registration: ClinicalTrials.gov (ID: NCT03134807).</p>}},
  author       = {{Flaatten, Hans and De Lange, Dylan W. and Morandi, Alessandro and Andersen, Finn H. and Artigas, Antonio and Bertolini, Guido and Boumendil, Ariane and Cecconi, Maurizio and Christensen, Steffen and Faraldi, Loredana and Fjølner, Jesper and Jung, Christian and Marsh, Brian and Moreno, Rui and Oeyen, Sandra and Öhman, Christina Agwald and Pinto, Bernardo Bollen and Soliman, Ivo W. and Szczeklik, Wojciech and Valentin, Andreas and Watson, Ximena and Zaferidis, Tilemachos and Guidet, Bertrand and Schmutz, René and Wimmer, Franz and Eller, Philipp and Zotter, Klemens and Swinnen, Walter and De Buysscher, Pieter and De Neve, Nikolaas and Abraham, Paul and Fleury, Yvan and Schefold, Joerg C. and Biskup, Ewelina and Taliadoros, Ioannis and Piza, Petr and Lauten, Alexander and Sacher, Anna Lena and Brenner, Thorsten and Franz, Marcus and Bloos, Frank and Ebelt, Henning and Schaller, Stefan J. and Wood, James and van Dijk, I. and Spångfors, Martin and Nilsson, Annika and Jungner, Mårten and Bark, Björn and Persson, Stefan}},
  issn         = {{0342-4642}},
  keywords     = {{Elderly; Frailty; ICU; Mortality; Octogenarians; Severity of illness}},
  language     = {{eng}},
  month        = {{12}},
  number       = {{12}},
  pages        = {{1820--1828}},
  publisher    = {{Springer}},
  series       = {{Intensive Care Medicine}},
  title        = {{The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (≥ 80 years)}},
  url          = {{http://dx.doi.org/10.1007/s00134-017-4940-8}},
  doi          = {{10.1007/s00134-017-4940-8}},
  volume       = {{43}},
  year         = {{2017}},
}