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Ueno R, Chan R, Ling RR, Slack R, Lussier S, Jones D, Pilcher D, Subramaniam A. Frailty and long-term survival of non-cancer patients admitted to intensive care after surgery: a retrospective multicentre cohort study. Br J Anaesth 2025; 134:1661-1670. [PMID: 40274508 PMCID: PMC12106905 DOI: 10.1016/j.bja.2025.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2024] [Revised: 02/10/2025] [Accepted: 03/04/2025] [Indexed: 04/26/2025] Open
Abstract
BACKGROUND As the global population ages and older patients undergo surgery, understanding the association between frailty and postoperative outcomes is crucial to informed decision-making and patient care. There is a lack of research assessing the association between frailty and long-term outcomes in patients admitted to ICUs after surgery. METHODS We conducted a multicentre retrospective cohort study using Australian and New Zealand Intensive Care Society Adult Patient Database, linked with the Australian National Death Index. Adults aged ≥16 yr admitted to the 175 ICUs in Australia between January 1, 2018, and March 31, 2022, after surgery were included. We excluded patients with cancer or admission to ICU for palliation or organ donation purpose. Patients with Clinical Frailty Scale score 5-8 were considered frail. The primary outcome was survival time up to 4 yr after ICU admission. Survival analysis was performed using mixed-effects Cox regression models and adjusted for age, sex, comorbidities, acute illness severity, and hospital types. RESULTS We included 216 922 patients of whom 30 860 (14.2%) were frail. Patients with frailty had shorter overall survival time (median [IQR]: 16 [6-29] vs 21 [10-34] months; P<0.01) when compared with patients without frailty. After adjusting for confounders, frailty was associated with a shorter time to death (HR: 2.33, 95% CI: 2.26-2.40). This association was consistent across sensitivity analyses and subgroups. Of note, this association between frailty and shorter time to death was more pronounced in patients aged <65 yr, those undergoing elective surgery, and those without treatment limitations. CONCLUSIONS In this multicentre study, frailty was associated with shorter time to death amongst postoperative ICU patients without cancer. The association was concordant across all subgroups.
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Affiliation(s)
- Ryo Ueno
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Rachel Chan
- Department of Anaesthesia and Pain Medicine, The Canberra Hospital, Canberra, Australia.
| | - Ryan Ruiyang Ling
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore; Department of Anaesthesia, National University Hospital, National University Health System, Singapore, Singapore
| | - Ryan Slack
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia
| | - Sandra Lussier
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia
| | - Daryl Jones
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Surgery and Critical Care, University of Melbourne, Melbourne, VIC, Australia
| | - David Pilcher
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, VIC, Australia; Department of Intensive Care, Alfred Hospital, Melbourne, VIC, Australia
| | - Ashwin Subramaniam
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Intensive Care, Peninsula Health, Frankston, VIC, Australia; Department of Intensive Care, Dandenong Hospital, Monash Health, Dandenong, VIC, Australia; Peninsula Clinical School, Monash University, Frankston, VIC, Australia; Department of Intensive Care, Epworth Healthcare, Richmond, VIC, Australia
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Schindele D, Berger MM, Gnass I. [The geriatric syndrome frailty in the context of readmission to the intensive care unit : Study protocol of a mixed-methods study]. Med Klin Intensivmed Notfmed 2025:10.1007/s00063-025-01280-x. [PMID: 40266318 DOI: 10.1007/s00063-025-01280-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2024] [Accepted: 03/27/2025] [Indexed: 04/24/2025]
Abstract
BACKGROUND Frailty syndrome is characterized by a decline in physiological reserves and a reduced resistance to internal and external stressors. In addition to a higher mortality rate, patients who are frail are more prone to complications during hospitalization, including admission to an intensive care unit (ICU). Studies indicated that frailty syndrome may serve as a predictor of readmission to the ICU. The impact of frailty syndrome on readmission to an ICU in Germany remains to be elucidated, as extant research primarily originates from non-German-speaking countries and is only partially transferable. AIM The primary objective of this study is to characterize the syndrome of frailty (measured using the Clinical Frailty Scale [CFS] ≥ 5) as a potential risk factor for readmission to the ICU. Secondly, the study will examine which factors, specifically nursing and medical measures on intermediate care and normal wards, can influence readmissions to the ICU. METHOD The study employs an explanatory sequential mixed-methods design, comprising a quantitative and a qualitative research phase. In the quantitative phase, a prospective cohort study will be conducted to investigate the association between frailty syndrome and ICU readmissions (≤ 30 days after discharge or during the same hospital stay) in patients ≥ 65 years of age. Concurrently, a document analysis will be conducted in the qualitative phase to identify care measures that could influence readmission. EXPECTED RESULTS The primary hypothesis of this study is that patients diagnosed with frailty syndrome (CFS ≥ 5) exhibit a higher risk of readmission to the ICU compared to non-frail patients. This inquiry will be conducted in the quantitative phase of the study. The qualitative research component is designed to elucidate non-intensive care measures that may influence readmission.
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Affiliation(s)
- Denise Schindele
- Paracelsus Medizinische Privatuniversität, Institut für Pflegewissenschaft und -praxis, Zentrum für Public Health und Versorgungsforschung, Strubergasse 21, 5020, Salzburg, Österreich.
- Regionale Kliniken Holding Ludwigsburg, RKH Akademie, Kurt-Lindemann-Weg 10, 71706, Markgröningen, Deutschland.
| | - Marc Moritz Berger
- RKH Klinikum Ludwigsburg, Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Posilipostraße 4, 71640, Ludwigsburg, Deutschland
| | - Irmela Gnass
- Paracelsus Medizinische Privatuniversität, Institut für Pflegewissenschaft und -praxis, Zentrum für Public Health und Versorgungsforschung, Strubergasse 21, 5020, Salzburg, Österreich
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Zaboli A, Brigo F, Sibilio S, Brigiari G, Massar M, Magnarelli G, Parodi M, Mian M, Pfeifer N, Turcato G. Assessing the utility of frailty scores in triage: a comparative study of validated scales. Intern Emerg Med 2025; 20:563-571. [PMID: 38900239 DOI: 10.1007/s11739-024-03684-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 06/14/2024] [Indexed: 06/21/2024]
Abstract
Currently, there is conflicting evidence regarding the efficacy of frailty scales and their ability to enhance or support triage operations. This study aimed to assess the utility of three common frailty scales (CFS, PRISMA-7, ISAR) and determine their utility in the triage setting. This prospective observational monocentric study was conducted at Merano Hospital's Emergency Department (ED) from June 1st to December 31st, 2023. All patients attending this ED during the 80-day study period were included, and frailty scores were correlated with three outcomes: hospitalization, 30-day mortality, and severity of condition as assessed by ED physicians. Patients were categorized by age, and analyses were performed for the entire study population, patients aged 18-64, and those aged 65 or older. Univariate analysis was followed by multivariable analysis to evaluate whether frailty scores were independently associated with the outcomes. In multivariable analysis, none of the frailty scores were found to be associated with the study outcomes, except for the CFS, which was associated with an increased risk of 30-day mortality, with an odds ratio of 1.752 (95% CI 1.148-2.674; p = 0.009) in the general population and 1.708 (95% CI 1.044-2.793; p = 0.033) in the population aged ≥ 65. Presently, available frailty scores do not appear to be useful in the triage context. Future research should consider developing new systems for accurate frailty assessment to support risk prediction in the triage assessment.
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Affiliation(s)
- Arian Zaboli
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Via A. Volta, 13°, Bolzano, Italy.
| | - Francesco Brigo
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Via A. Volta, 13°, Bolzano, Italy
| | - Serena Sibilio
- Department Public Health, Institute of Nursing Science, Universitat Basel, Basel, BS, Switzerland
| | - Gloria Brigiari
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Magdalena Massar
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Via A. Volta, 13°, Bolzano, Italy
| | - Gabriele Magnarelli
- Department of Emergency Medicine, Hospital of Merano-Meran (SABES-ASDAA), Merano-Meran, Italy
- Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Salzburg, Austria
| | - Marta Parodi
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy
| | - Michael Mian
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Via A. Volta, 13°, Bolzano, Italy
- College of Health Care-Professions Claudiana, Bozen, Italy
| | - Norbert Pfeifer
- Department of Emergency Medicine, Hospital of Merano-Meran (SABES-ASDAA), Merano-Meran, Italy
| | - Gianni Turcato
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy
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Molina Lobo R, Gordo Vidal F, Prieto López L, Torrejón Pérez I, Naharro Abellán A, Salinas Gabiña I, Lobo Valbuena B. Analysis of frailty as a prognostic factor independent of age: A prospective observational study. Med Intensiva 2025:502144. [PMID: 40011086 DOI: 10.1016/j.medine.2025.502144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 10/11/2024] [Accepted: 11/03/2024] [Indexed: 02/28/2025]
Abstract
OBJECTIVE Analyze the effects of frailty and prefrailty in patients admitted to the ICU without age limits and to determine the factors associated with mortality. DESIGN Prospective cohort. SETTING Intensive Care Unit, Spain. PATIENTS 1462 critically ill patients without age limits. INTERVENTION None. MAIN VARIABLES OF INTEREST Hospital mortality and health outcomes. RESULTS Patients' ages ranged from 15 to 93 years, median of 66 years. Predisposing factors independently associated with frailty and prefrailty were age older than 65 years, female sex, respiratory and renal comorbidities, longer pre-ICU stays, and weekend admission. There is a greater use of noninvasive mechanical ventilation, greater colonization by multidrug-resistant bacteria, and the development of delirium. The risk of hospital mortality was RR 4.04 (2.11-7.74; P<.001) for prefail and 5.88 (2.45-14.10; P<.001) for frail. Factors associated with in-hospital mortality in prefrail and frail were pre-ICU hospital length of stay (cutpoint 4.5 days [1.6-7.4]), greater severity on admission (SAPS3) (cutpoint 64.5 [63.6-65.4]), Glasgow Coma Scale deterioration (OR 4.14 [1.23-13.98]; P .022) and thrombocytopenia (OR 11.46 [2.21-59.42]; P .004). CONCLUSIONS Lower levels of frailty are most common in ICU patients and are associated with worse health outcomes. Our data suggest that frailty and pre frailty should be determined in all patients admitted to the ICU, regardless of their age.
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Affiliation(s)
- Rosario Molina Lobo
- Intensive Care Unit, Hospital Universitario del Henares, Coslada, Madrid, Spain; Critical Pathology Researh Group (Grupo de Investigación en Patología Crítica), Facultad de Medicina, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain; Infanta Sofia University Hospital and Henares University Hospital Foundation for Biomedical Research and Innovation (FIIB, HUIS, HUHEN), Madrid, Spain.
| | - Federico Gordo Vidal
- Intensive Care Unit, Hospital Universitario del Henares, Coslada, Madrid, Spain; Critical Pathology Researh Group (Grupo de Investigación en Patología Crítica), Facultad de Medicina, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain; Infanta Sofia University Hospital and Henares University Hospital Foundation for Biomedical Research and Innovation (FIIB, HUIS, HUHEN), Madrid, Spain
| | - Lola Prieto López
- Department of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| | - Inés Torrejón Pérez
- Intensive Care Unit, Hospital Universitario del Henares, Coslada, Madrid, Spain
| | - Antonio Naharro Abellán
- Intensive Care Unit, Hospital Universitario del Henares, Coslada, Madrid, Spain; Critical Pathology Researh Group (Grupo de Investigación en Patología Crítica), Facultad de Medicina, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | | | - Beatriz Lobo Valbuena
- Intensive Care Unit, Hospital Universitario del Henares, Coslada, Madrid, Spain; Critical Pathology Researh Group (Grupo de Investigación en Patología Crítica), Facultad de Medicina, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain; Infanta Sofia University Hospital and Henares University Hospital Foundation for Biomedical Research and Innovation (FIIB, HUIS, HUHEN), Madrid, Spain
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Statlender L, Theou O, Merchshiev R, Shochat T, Kagan I, Cooper L. The pictorial fit-frail scale: a novel tool for frailty assessment in critically ill older adults. BMC Geriatr 2025; 25:105. [PMID: 39962424 PMCID: PMC11831822 DOI: 10.1186/s12877-025-05773-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2024] [Accepted: 02/07/2025] [Indexed: 02/21/2025] Open
Abstract
BACKGROUND Frailty is a state of high vulnerability to adverse health outcomes. It is an important factor influencing the prognosis of older, critically ill patients. Several methods to assess frailty were evaluated in the critical care setting. The Pictorial Fit-Frail Scale (PFFS) is a validated quick and easy-to-use tool for frailty assessment. It takes < 5 min to fill by the patient or caregiver; it requires no clinical examination by medical staff. This study evaluated the use of the PFFS in an intensive care unit (ICU). METHODS A single-center retrospective study, performed in an 18-bed mixed medical-surgical ICU in a university-affiliated tertiary hospital. As of 1/9/2022, all older patients are routinely asked to fill out the PFFS. Patients were grouped based on their PFFS score. Baseline characteristics and admission outcomes were compared. Correlation between the PFFS and prognostic scores was examined. Mortality was analyzed using logistic and Cox regressions. RESULTS 168 patients were included. 56 (33.33%) patients were non-frail, 81 (48.21%) were mildly-moderately frail, and 31 (18.45%) were severely frail. There were no differences in baseline characteristics or prognostic scores between frailty groups. No correlation was found between PFFS, age, APACHE2, and SOFA24. Multivariate logistic regression demonstrated an association between frailty and 90d but not with ICU mortality. Cox regression demonstrated higher mortality in the mild-moderate frailty (HR 2.053, 95%CI 1.009, 4.179) and severe frailty (HR 4.353, (95% CI 1.934, 9.801)) groups compared to the non-frail group. CONCLUSION Frailty assessment by the PFFS in the ICU is feasible. Frailty is a distinct characteristic of older, critically ill patients and is independently associated with 90d mortality.
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Affiliation(s)
- Liran Statlender
- Department of General Intensive Care, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel.
- School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Olga Theou
- School of Physiotherapy, Dalhousie University, Halifax, NS, B3H 4R2, Canada
- Geriatric Medicine, Dalhousie University, Halifax, NS, B3H 2E1, Canada
| | - Regina Merchshiev
- Department of General Intensive Care, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel
| | - Tzippy Shochat
- Statistical consulting unit, Rabin Medical Centre, Petah Tikva, Israel
| | - Ilya Kagan
- Department of General Intensive Care, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute for Nutrition Research, Felsenstein Medical Research Centre, Petah Tikva, Israel
| | - Lisa Cooper
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Geriatric Medicine, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
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O'Rorke S, Tipping CJ, Lodge M, Mathew J, Kimmel L. Frailty across the adult age spectrum and its effects on outcomes: Experience from a level 1 trauma centre. Injury 2025; 56:112037. [PMID: 39615310 DOI: 10.1016/j.injury.2024.112037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Revised: 11/12/2024] [Accepted: 11/16/2024] [Indexed: 02/07/2025]
Abstract
BACKGROUND Recent evidence suggests that frailty may be a more reliable measure than age to predict outcomes following trauma. Frailty leads to prolonged hospitalisation and increased burden on the hospital system in older patients. The aim of this study is to review the prevalence of frailty in our trauma patients and the association of frailty with hospital-based and twelve-month outcomes. METHODS Patient demographics, discharge destination, hospital length of stay (LOS), and functional status at 12 months were reviewed. Frailty was assessed using the Clinical Frailty Scale (score <4 non frail, 4 vulnerable, >4 frail). Factors associated with frailty and outcomes including discharge destination (home or inpatient care) and LOS (p value <0.2) were included in multivariate models. RESULTS There were 1230 patients admitted to the trauma ward between November 2020-August 2021 who had linked registry data. Of these, 217 (17.6 %) were deemed frail with 131 (10.7 %) being vulnerable. In the group over 65 years, 38.6 % were frail and 16.1 % were vulnerable. Accounting for confounding factors (including age), being frail was associated with discharge to further inpatient care (AOR 4.82 (3.02 - 7.68), p value <0.001). At 12 months post injury, the mortality rate of patients with frailty was 28 %, compared to 2 % for the rest of the population and patients reported significantly more problems with undertaking daily tasks such as mobility and self-care. CONCLUSION After adjusting for confounding factors, frailty is associated with nearly five times the increase in odds of a discharge to further inpatient care. Long term outcomes are also significantly poorer for patients with frailty. Identifying frailty on admission may help outcomes by targeting this patient group and optimising healthcare resource usage.
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Affiliation(s)
- Sarah O'Rorke
- Physiotherapy Department, Alfred Hospital, Melbourne, Australia
| | | | - Margot Lodge
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Health of Older People, Alfred Health, Melbourne, Australia; National Trauma Research Institute, Melbourne, Australia; School of Translational Medicine, Monash University, Melbourne, Australia
| | - Joseph Mathew
- National Trauma Research Institute, Melbourne, Australia; School of Translational Medicine, Monash University, Melbourne, Australia; Alfred Trauma service, Alfred Hospital, Melbourne, Australia
| | - Lara Kimmel
- Physiotherapy Department, Alfred Hospital, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Allied Health Executive, Alfred Hospital, Melbourne, Australia.
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Minnema J, Lafeber M, Sablerolles RS, van Kempen JA, Tap L, Polinder-Bos HA, van de Loo BP, van der Kuy H, Faes MC. Association between Clinical Frailty Scale and mortality 24 months after hospitalisation in adult patients with COVID-19. Heliyon 2024; 10:e40456. [PMID: 39688505 PMCID: PMC11648057 DOI: 10.1016/j.heliyon.2024.e40456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/13/2024] [Accepted: 11/14/2024] [Indexed: 12/18/2024] Open
Abstract
Background The clinical frailty scale (CFS) was used as a triage tool for medical decision making during the COVID-19 pandemic. The CFS has been posed as a suitable risk marker for in-hospital mortality in COVID-19 patients. We evaluated whether the CFS is associated with mortality 24 months after hospitalisation for COVID-19. Methods The COvid MEdicaTion (COMET) study is an international, multicentre, observational cohort study, including adult patients hospitalised for COVID-19 between March 2020-July 2020. Patients' characteristics, prescribed medication, clinical characteristics, and CFS were collected at admission, survival data were collected 24 months after hospitalisation. Multivariable cox proportional hazard models stratified by age (<65 and ≥65 years), and adjusted for covariates (age, sex, number of drugs, and types of drug class as a proxy for comorbidities) were used to study the association between the CFS and 24-month mortality after hospitalisation. Results In this study, 1238 fit (CFS 1-3), 478 mildly frail (CFS 4-5), and 235 frail (CFS 6-9) patients were included for baseline analysis (median age 68 years (IQR 58-78); 58.5 % male). Frailty was associated with an increased risk of 24-month mortality after hospitalisation in older patients (HR 1.91, 95 % CI [1.17-3.12]), in younger adults a trend was seen (HR 3.13, 95 % CI [0.86-11.36]). Conclusion The results suggest that the CFS is an indicator for mortality 24 months after hospitalisation in COVID-19 patients.
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Affiliation(s)
- Julia Minnema
- Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, the Netherlands
- Department of Hospital Pharmacy, Erasmus MC, University Medical Centre Rotterdam, the Netherlands
| | - Melvin Lafeber
- Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, the Netherlands
| | - Roos S.G. Sablerolles
- Department of Hospital Pharmacy, Erasmus MC, University Medical Centre Rotterdam, the Netherlands
| | | | - Lisanne Tap
- Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, the Netherlands
| | - Harmke A. Polinder-Bos
- Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, the Netherlands
| | | | - Hugo van der Kuy
- Department of Hospital Pharmacy, Erasmus MC, University Medical Centre Rotterdam, the Netherlands
| | - Miriam C. Faes
- Department of Geriatrics, Amphia Hospital, Breda, the Netherlands
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Li X, Tang Y, Deng X, Zhou F, Huang X, Bai Z, Liang X, Wang Y, Lyu J. Modified frailty index effectively predicts adverse outcomes in sepsis patients in the intensive care unit. Intensive Crit Care Nurs 2024; 84:103749. [PMID: 38896964 DOI: 10.1016/j.iccn.2024.103749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Frailty and sepsis have a significant impact on patient prognosis. However, research into the relationship between frailty and sepsis in the general adult population remains inadequate. This paper aims to investigate the association between frailty and adverse outcomes in this population. METHOD This retrospective analysis investigated sepsis patients who were initially admitted to the intensive care unit (ICU). The Modified Frailty Index (MFI) was derived by tracking patients' International Classification of Diseases (ICD) codes during their hospitalization. Patients were classified into two groups based on their MFI scores: a frail group (MFI ≥ 3) and a non-frail group (MFI = 0-2). The key outcomes were mortality rates at 90 and 180 days, with secondary outcomes including the incidence of delirium and pressure injury. RESULT Of the 21,338 patients who were recruited for this study (median age about 68 years, 41.8 % female), 5,507 were classified as frail and 15,831 were classified as non-frail. Frail patients were significantly more likely to have delirium (48.9 % vs. 36.1 %, p < 0.001) and pressure injury (60.5 % vs. 51.4 %, p < 0.001). After controlling for confounding variables, the multifactorial Cox proportional hazard regression analyses revealed a significantly elevated mortality rate at 90 days (adjusted HR: 1.58, 95 % CI: 1.24-2.02, p < 0.001) and 180 days (adjusted HR: 1.47, 95 % CI: 1.18, 1.83, p < 0.001) in the frail group compared to their non-frail counterparts. CONCLUSIONS Frailty independently predisposes adult sepsis patients in the ICU to adverse outcomes. Future investigations should concentrate on evaluating frailty and developing targeted interventions to improve patient prognosis. IMPLICATION FOR CLINICAL PRACTICE The MFI provides a simple clinical assessment tool that can be integrated into electronic medical records for immediate calculation. This simplifies the assessment process and plays a key role in predicting patient outcomes.
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Affiliation(s)
- Xinya Li
- School of Nursing, Jinan University, Guangzhou, China
| | - Yonglan Tang
- School of Nursing, Jinan University, Guangzhou, China
| | - Xingwen Deng
- Department of Medical Information, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Fuling Zhou
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiaxuan Huang
- Department of Neurology, the First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zihong Bai
- Department of Neurology, the First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xin Liang
- School of Nursing, Jinan University, Guangzhou, China
| | - Yu Wang
- School of Nursing, Jinan University, Guangzhou, China; Community Health Service Center of Jinan University, Guangzhou, China; Department of School Clinic, the First Affiliated Hospital of Jinan University, Guangzhou, China.
| | - Jun Lyu
- Department of Clinical Research, the First Affiliated Hospital of Jinan University, Guangzhou, China.
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Zaboli A, Sibilio S, Brigiari G, Massar M, Parodi M, Magnarelli G, Brigo F, Turcato G. External validation of the TFC (triage frailty and comorbidity) tool: a prospective observational study. Intern Emerg Med 2024:10.1007/s11739-024-03757-7. [PMID: 39240411 DOI: 10.1007/s11739-024-03757-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 08/27/2024] [Indexed: 09/07/2024]
Abstract
Assessing patient frailty during triage evaluations has become increasingly relevant in Emergency Departments (ED). This study aimed to externally validating the Triage Frailty and Comorbidity (TFC) tool. This prospective study was conducted from June 1 to December 31, 2023. During this period, 12 triage nurses applied the TFC tool during triage evaluation of ED patients. We used receiver operating characteristic (ROC) curves and Decision Curve Analysis to assess the predictive ability of the TFC tool for a 90-day mortality (the same endpoint used during tool development) and a 30-day mortality. 1270 patients were included and 56 of them died within 90 days. The TFC tool had an AUROC of 0.894 (0.858-0.929) for 90-day mortality and 0.885 (0.834-0.938) for 30-day mortality. In Decision Curve Analysis, it yielded higher net benefits up to a threshold probability of 0.30. The externally validated TFC tool appears very effective at identifying patients with increased risk of 90-day mortality after ED attendance. It could be implemented in clinical practice and enhance the predictive ability of standard triage systems.
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Affiliation(s)
- Arian Zaboli
- Innovation, Research and Teaching Service, SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Via A. Volta, 13°, Bolzano, Italy.
| | - Serena Sibilio
- Department Public Health, Institute of Nursing Science, Universitat Basel, Basel, Switzerland
| | - Gloria Brigiari
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Vascular Sciences and Public Health, University of Padova, ThoracicPadua, Italy
| | - Magdalena Massar
- Innovation, Research and Teaching Service, SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Via A. Volta, 13°, Bolzano, Italy
| | - Marta Parodi
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy
| | - Gabriele Magnarelli
- Department of Emergency Medicine, Hospital of Merano-Meran (SABES-ASDAA), Merano-Meran, Italy
- Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Salzburg, Austria
| | - Francesco Brigo
- Innovation, Research and Teaching Service, SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Via A. Volta, 13°, Bolzano, Italy
| | - Gianni Turcato
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy
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10
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Koerber DM, Katz JN, Bohula E, Park JG, Dodson MW, Gerber DA, Hillerson D, Liu S, Pierce MJ, Prasad R, Rose SW, Sanchez PA, Shaw J, Wang J, Jentzer JC, Kristin Newby L, Daniels LB, Morrow DA, van Diepen S. Variation in risk-adjusted cardiac intensive care unit (CICU) length of stay and the association with in-hospital mortality: An analysis from the Critical Care Cardiology Trials Network (CCCTN) registry. Am Heart J 2024; 271:28-37. [PMID: 38369218 DOI: 10.1016/j.ahj.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/13/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Previous studies have suggested that there is wide variability in cardiac intensive care unit (CICU) length of stay (LOS); however, these studies are limited by the absence of detailed risk assessment at the time of admission. Thus, we evaluated inter-hospital differences in CICU LOS, and the association between LOS and in-hospital mortality. METHODS Using data from the Critical Care Cardiology Trials Network (CCCTN) registry, we included 22,862 admissions between 2017 and 2022 from 35 primarily tertiary and quaternary CICUs that captured consecutive admissions in annual 2-month snapshots. The primary analysis compared inter-hospital differences in CICU LOS, as well as the association between CICU LOS and all-cause in-hospital mortality using a Fine and Gray competing risk model. RESULTS The overall median CICU LOS was 2.2 (1.1-4.8) days, and the median hospital LOS was 5.9 (2.8-12.3) days. Admissions in the longest tertile of LOS tended to be younger with higher rates of pre-existing comorbidities, and had higher Sequential Organ Failure Assessment (SOFA) scores, as well as higher rates of mechanical ventilation, intravenous vasopressor use, mechanical circulatory support, and renal replacement therapy. Unadjusted all-cause in-hospital mortality was 9.3%, 6.7%, and 13.4% in the lowest, intermediate, and highest CICU LOS tertiles. In a competing risk analysis, individual patient CICU LOS was correlated (r2 = 0.31) with a higher risk of 30-day in-hospital mortality. The relationship remained significant in admissions with heart failure, ST-elevation myocardial infarction and non-ST segment elevation myocardial infarction. CONCLUSIONS In a large registry of academic CICUs, we observed significant variation in CICU LOS and report that LOS is independently associated with all-cause in-hospital mortality. These findings could potentially be used to improve CICU resource utilization planning and refine risk prognostication in critically ill cardiovascular patients.
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Affiliation(s)
- Daniel M Koerber
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Erin Bohula
- Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jeong-Gun Park
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Mark W Dodson
- Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT
| | - Daniel A Gerber
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA
| | - Dustin Hillerson
- Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Shuangbo Liu
- Max Rady College of Medicine, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Matthew J Pierce
- North Shore University Hospital, Northwell Health, Manhasset, NY, USA
| | | | - Scott W Rose
- Atrium Health Wake Forest Baptist, Winston-Salem, NC
| | - Pablo A Sanchez
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA
| | - Jeffrey Shaw
- Division of Cardiology, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - L Kristin Newby
- Division of Cardiology, Department of Medicine, Duke Clinical Research Institute, Durham, NC
| | - Lori B Daniels
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, La Jolla, CA
| | - David A Morrow
- Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sean van Diepen
- Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
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11
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Subramaniam A, Ling RR, Pilcher D. Impact of frailty on long-term survival in patients discharged alive from hospital after an ICU admission with COVID-19. CRIT CARE RESUSC 2024; 26:16-23. [PMID: 38690183 PMCID: PMC11056397 DOI: 10.1016/j.ccrj.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/03/2023] [Indexed: 05/02/2024]
Abstract
Objective Though frailty is associated with mortality, its impact on long-term survival after an ICU admission with COVID-19 is unclear. We aimed to investigate the association between frailty and long-term survival in patients after an ICU admission with COVID-19. Design Setting and Participants This registry-based multicentre, retrospective, cohort study included all patients ≥16 years discharged alive from the hospital following an ICU admission with COVID-19 and documented clinical frailty scale (CFS). Data from 118 ICUs between 01/01/2020 through 31/12/2020 in New Zealand and 31/12/2021 in Australia were reported in the Australian and New Zealand Intensive Care Society Adult Patient Database. The patients were categorised as 'not frail' (CFS 1-3), 'mildly frail' (CFS 4-5) and 'moderately-to-severely frail' (CFS 6-8). Main Outcome Measures The primary outcome was survival time up to two years, which we analysed using Cox regression models. Results We included 4028 patients with COVID-19 in the final analysis. 'Moderately-to-severely frail' patients were older (66.6 [56.3-75.8] vs. 69.9 [60.3-78.1]; p < 0.001) than those without frailty (median [interquartile range] 53.0 [40.1-64.6]), had higher sequential organ failure assessment scores (p < 0.001), and less likely to receive mechanical ventilation (p < 0.001) than patients without frailty or mild frailty. After adjusting for confounders, patients with mild frailty (adjusted hazards ratio: 2.31, 95%-CI: 1.75-3.05) and moderate-to-severe frailty (adjusted hazards ratio: 2.54, 95%-CI: 1.89-3.42) had higher mortality rates than those without frailty. Conclusions Frailty was independently associated with shorter survival times to two years in patients with severe COVID-19 in ANZ following hospital discharge. Recognising frailty provides individualised patient intervention in those with frailty admitted to ICUs with severe COVID-19. Clinical trial registration Not applicable.
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Affiliation(s)
- Ashwin Subramaniam
- Department of Intensive Care, Peninsula Health, Frankston, Victoria, Australia
- Department of Intensive Care, Dandenong Hospital, Monash Health, Dandenong, Victoria, Australia
- Peninsula Clinical School, Monash University, Frankston, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ryan Ruiyang Ling
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - David Pilcher
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care, Alfred Hospital, Melbourne, Victoria, Australia
- Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, Victoria, Australia
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12
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Wozniak H, Beckmann TS, Dos Santos Rocha A, Pugin J, Heidegger CP, Cereghetti S. Long-stay ICU patients with frailty: mortality and recovery outcomes at 6 months. Ann Intensive Care 2024; 14:31. [PMID: 38401034 PMCID: PMC10894177 DOI: 10.1186/s13613-024-01261-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/09/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Prolonged intensive care unit (ICU) stay is associated with physical, cognitive, and psychological disabilities. The impact of baseline frailty on long-stay ICU patients remains uncertain. This study aims to investigate how baseline frailty influences mortality and post-ICU disability 6 months after critical illness in long-stay ICU patients. METHODS In this retrospective cohort study, we assessed patients hospitalized for ≥ 7 days in the ICU between May 2018 and May 2021, following them for up to 6 months or until death. Based on the Clinical Frailty Scale (CFS) at ICU admissions, patients were categorized as frail (CFS ≥ 5), pre-frail (CFS 3-4) and non-frail (CFS 1-2). Kaplan-Meier curves and a multivariate Cox model were used to examine the association between frailty and mortality. At the 6 month follow-up, we assessed psychological, physical, cognitive outcomes, and health-related quality of life (QoL) using descriptive statistics and linear regressions. RESULTS We enrolled 531 patients, of which 178 (33.6%) were frail, 200 (37.6%) pre-frail and 153 (28.8%) non-frail. Frail patients were older, had more comorbidities, and greater disease severity at ICU admission. At 6 months, frail patients presented higher mortality rates than pre-frail and non-frail patients (34.3% (61/178) vs. 21% (42/200) vs. 13.1% (20/153) respectively, p < 0.01). The rate of withdrawing or withholding of care did not differ significantly between the groups. Compared with CFS 1-2, the adjusted hazard ratios of death at 6 months were 1.7 (95% CI 0.9-2.9) for CFS 3-4 and 2.9 (95% CI 1.7-4.9) for CFS ≥ 5. At 6 months, 192 patients were seen at a follow-up consultation. In multivariate linear regressions, CFS ≥ 5 was associated with poorer physical health-related QoL, but not with poorer mental health-related QoL, compared with CFS 1-2. CONCLUSION Frailty is associated with increased mortality and poorer physical health-related QoL in long-stay ICU patients at 6 months. The admission CFS can help inform patients and families about the complexities of survivorship during a prolonged ICU stay.
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Affiliation(s)
- Hannah Wozniak
- Division of Critical Care, Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland.
- Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
| | - Tal Sarah Beckmann
- Division of Anesthesiology, Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - Andre Dos Santos Rocha
- Division of Anesthesiology, Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - Jérôme Pugin
- Division of Critical Care, Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - Claudia-Paula Heidegger
- Division of Critical Care, Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - Sara Cereghetti
- Division of Critical Care, Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland
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