by David Sanchez, Kathleen Brennan, Masar Al Sayfe,
Sharon-Ann Shunker, Tony Bogdanoski, Sonja Hedges, Yu Chin Hou, Joan Lynch,
Leanne Hunt, Evan Alexandrou, Manoj Saxena, Simon Abel, Ramanathan Lakshmanan,
Deepak Bhonagiri, Michael J. Parr, Anders Aneman…
Critical Care volume 24,
Article number: 609 (2020) Published: 15
October 2020
Background
Clinical frailty among older adults admitted to intensive
care has been proposed as an important determinant of patient outcomes. Among
this group of patients, an acute episode of delirium is also common, but its
relationship to frailty and increased risk of mortality has not been
extensively explored. Therefore, the aim of this study was to explore the
relationship between clinical frailty, delirium and hospital mortality of older
adults admitted to intensive care.
Methods
This study is part of a Delirium in Intensive Care (Deli)
Study. During the initial 6-month baseline period, clinical frailty status on
admission to intensive care, among adults aged 50 years or more; acute
episodes of delirium; and the outcomes of intensive care and hospital stay were
explored.
Results
During the 6-month baseline period, 997 patients, aged
50 years or more, were included in this study. The average age was 71
years (IQR, 63–79); 55% were male (n = 537). Among these patients, 39.2% (95%
CI 36.1–42.3%, n = 396) had a Clinical Frailty Score (CFS) of 5 or more,
and 13.0% (n = 127) had at least one acute episode of delirium. Frail patients
were at greater risk of an episode of delirium (17% versus 10%, adjusted rate
ratio (adjRR) = 1.71, 95% confidence interval (CI) 1.20–2.43, p = 0.003),
had a longer hospital stay (2.6 days, 95% CI 1–7 days, p = 0.009) and had
a higher risk of hospital mortality (19% versus 7%, adjRR = 2.54, 95% CI
1.72–3.75, p < 0.001), when compared to non-frail patients. Patients
who were frail and experienced an acute episode of delirium in the intensive
care had a 35% rate of hospital mortality versus 10% among non-frail patients
who also experienced delirium in the ICU.
Conclusion
Frailty and delirium significantly increase the risk of
hospital mortality. Therefore, it is important to identify patients who are
frail and institute measures to reduce the risk of adverse events in the ICU
such as delirium and, importantly, to discuss these issues in an open and
empathetic way with the patient and their families.
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