by Ashwin Subramaniam, Ryo Ueno, Ravindranath Tiruvoipati,
Velandai Srikanth, Michael Bailey and David Pilcher
Critical Care volume 26,
Article number: 121 (2022) Published: 03
May 2022
Background
The Clinical Frailty Scale (CFS) is the most commonly used
frailty measure in intensive care unit (ICU) patients. The hospital frailty
risk score (HFRS) was recently proposed for the quantification of frailty. We
aimed to compare the HFRS with the CFS in critically ill patients in predicting
long-term survival up to one year following ICU admission.
Methods
In this retrospective multicentre cohort study from 16
public ICUs in the state of Victoria, Australia between 1st January 2017 and
30th June 2018, ICU admission episodes listed in the Australian and New Zealand
Intensive Care Society Adult Patient Database registry with a documented CFS,
which had been linked with the Victorian Admitted Episode Dataset and the
Victorian Death Index were examined. The HFRS was calculated for each patient
using the International Statistical Classification of Diseases and Related
Health Problems, Tenth Revision (ICD-10) codes that represented pre-existing
conditions at the time of index hospital admission. Descriptive methods, Cox
proportional hazards and area under the receiver operating characteristic
(AUROC) were used to investigate the association between each frailty score and
long-term survival up to 1 year, after adjusting for confounders including
sex and baseline severity of illness on admission to ICU (Australia New Zealand
risk-of-death, ANZROD).
Results
7001 ICU patients with both frailty measures were analysed.
The overall median (IQR) age was 63.7 (49.1–74.0) years; 59.5% (n = 4166) were
male; the median (IQR) APACHE II score 14 (10–20). Almost half (46.7%, n = 3266)
were mechanically ventilated. The hospital mortality was 9.5% (n = 642) and
1-year mortality was 14.4% (n = 1005). HFRS correlated weakly with CFS
(Spearman’s rho 0.13 (95% CI 0.10–0.15) and had a poor agreement (kappa = 0.12,
95% CI 0.10–0.15). Both frailty measures predicted 1-year survival after
adjusting for confounders, CFS (HR 1.26, 95% CI 1.21–1.31) and HFRS (HR 1.08,
95% CI 1.02–1.15). The CFS had better discrimination of 1-year mortality than
HFRS (AUROC 0.66 vs 0.63 p < 0.0001).
Conclusion
Both HFRS and CFS independently predicted up to 1-year
survival following an ICU admission with moderate discrimination. The CFS was a
better predictor of 1-year survival than the HFRS.
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