by Lina De Geer,
Mats Fredrikson and Michelle S. Chew
Annals of
Intensive Care volume 12,
Article number: 120 (2022)
Background
While frailty is a known predictor of adverse outcomes in
older patients, its effect in younger populations is unknown. This prospective
observational study was conducted in a tertiary-level mixed ICU to assess the
impact of frailty on long-term survival in intensive care patients of different
ages.
Methods
Data on premorbid frailty (Clinical Frailty Score; CFS),
severity of illness (the Simplified Acute Physiology Score, third version;
SAPS3), limitations of care and outcome were collected in 817 adult ICU
patients. Hazard ratios (HR) for death within 180 days after ICU admission
were calculated. Unadjusted and adjusted analyses were used to evaluate the
association of frailty with outcome in different age groups.
Results
Patients were classified into predefined age groups
(18–49 years (n = 241), 50–64 (n = 188), 65–79 (n = 311) and 80 years
or older (n = 77)). The proportion of frail (CFS ≥ 5) patients was 41% (n = 333)
in the overall population and increased with each age strata (n = 46 (19%)
vs. n = 67 (36%) vs. n = 174 (56%) vs. n = 46 (60%), P < 0.05).
Frail patients had higher SAPS3, more treatment restrictions and higher ICU
mortality. Frailty was associated with an increased risk of 180-day mortality
in all age groups (HR 5.7 (95% CI 2.8–11.4), P < 0.05; 8.0
(4.0–16.2), P < 0.05; 4.1 (2.2–6.6), P < 0.05; 2.4 (1.1–5.0), P = 0.02).
The effect remained significant after adjustment for SAPS3, comorbidity and
limitations of treatment only in patients aged 50–64 (2.1 (1.1–3.1), P < 0.05).
Conclusions
Premorbid frailty is common in ICU patients of all ages and
was found in 55% of patients aged under 64 years. Frailty was
independently associated with mortality only among middle-aged patients, where
the risk of death was increased twofold. Our study supports the use of frailty
assessment in identifying younger ICU patients at a higher risk of death.
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