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

Hans Flaatten; Dylan W. De Lange; Alessandro Morandi; Finn H. Andersen; Antonio Artigas; Guido Bertolini; Ariane Boumendil; Maurizio Cecconi; Steffen Christensen; Loredana Faraldi; Jesper Fjølner; Christian Jung; Brian Marsh; Rui Moreno; Sandra Oeyen; Christina Agwald Öhman; Bernardo Bollen Pinto; Ivo W. Soliman; Wojciech Szczeklik; Andreas Valentin; Ximena Watson; Tilemachos Zaferidis; Bertrand Guidet; René Schmutz; Franz Wimmer; Philipp Eller; Klemens Zotter; Walter Swinnen; Pieter De Buysscher; Nikolaas De Neve; Paul Abraham; Yvan Fleury; Joerg C. Schefold; Ewelina Biskup; Ioannis Taliadoros; Petr Piza; Alexander Lauten; Anna Lena Sacher; Thorsten Brenner; Marcus Franz; Frank Bloos; Henning Ebelt; Stefan J. Schaller; Kristina Fuest; Christian Rabe; Thorben Dieck; Stephan Steiner; Tobias Graf; Amir M. Nia; Rolf Alexander Janosi; Patrick Meybohm; Philipp Simon; Stefan Utzolino; Tim Rahmel; Eberhard Barth; Michael Schuster; Nilanjan Dey; Christoffer Sølling; Bodil Steen Rasmussen; Enver Rodriguez; Sergio Rebollo; Gerardo Aguilar; Gaspar Masdeu; Marián Irazábal Jaimes; Ángela Prado Mira; Maria A. Bodi; Jesus A. Barea Mendoza; Sonia López-Cuenca; Marcela Homez Guzman; Jesús Rico-Feijoo; Mercedes Ibarz; Josep Trenado-Alvarez; Xavier Forceville; Guillaume Besch; Herve Mentec; Philippe Michel; Philippe Mateu; Lucie Vettoretti; Jeremy Bourenne; Nathalie Marin; Max Guillot; Naida Aissaoui; Cyril Goulenok; Nathalie Thieulot-Rolin; Jonathan Messika; Lionel Lamhaut; Cyril Charron; Ged Dempsey; Shiju J. Mathew; Ashok S. Raj; Irina Grecu; Jason Cupitt; Tom Lawton; Richard Clark; Monica Popescu; Nick Spittle; Maria Faulkner; Amanda Cowton; Esme Elloway; Patricia Williams

doi:10.1007/s00134-017-4940-8

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

Hans Flaatten, Dylan W. De Lange, Alessandro Morandi, Finn H. Andersen, Antonio Artigas, Guido Bertolini, Ariane Boumendil, Maurizio Cecconi, Steffen Christensen, Loredana Faraldi, Jesper Fjølner, Christian Jung, Brian Marsh, Rui Moreno, Sandra Oeyen, Christina Agwald Öhman, Bernardo Bollen Pinto, Ivo W. Soliman, Wojciech Szczeklik, Andreas ValentinXimena Watson, Tilemachos Zaferidis, Bertrand Guidet, René Schmutz, Franz Wimmer, Philipp Eller, Klemens Zotter, Walter Swinnen, Pieter De Buysscher, Nikolaas De Neve, Paul Abraham, Yvan Fleury, Joerg C. Schefold, Ewelina Biskup, Ioannis Taliadoros, Petr Piza, Alexander Lauten, Anna Lena Sacher, Thorsten Brenner, Marcus Franz, Frank Bloos, Henning Ebelt, Stefan J. Schaller, Kristina Fuest, Christian Rabe, Thorben Dieck, Stephan Steiner, Tobias Graf, Amir M. Nia, Rolf Alexander Janosi, Patrick Meybohm, Philipp Simon, Stefan Utzolino, Tim Rahmel, Eberhard Barth, Michael Schuster, Nilanjan Dey, Christoffer Sølling, Bodil Steen Rasmussen, Enver Rodriguez, Sergio Rebollo, Gerardo Aguilar, Gaspar Masdeu, Marián Irazábal Jaimes, Ángela Prado Mira, Maria A. Bodi, Jesus A. Barea Mendoza, Sonia López-Cuenca, Marcela Homez Guzman, Jesús Rico-Feijoo, Mercedes Ibarz, Josep Trenado-Alvarez, Xavier Forceville, Guillaume Besch, Herve Mentec, Philippe Michel, Philippe Mateu, Lucie Vettoretti, Jeremy Bourenne, Nathalie Marin, Max Guillot, Naida Aissaoui, Cyril Goulenok, Nathalie Thieulot-Rolin, Jonathan Messika, Lionel Lamhaut, Cyril Charron, Ged Dempsey, Shiju J. Mathew, Ashok S. Raj, Irina Grecu, Jason Cupitt, Tom Lawton, Richard Clark, Monica Popescu, Nick Spittle, Maria Faulkner, Amanda Cowton, Esme Elloway, Patricia Williams

Departament de Medicina

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© 2017, Springer-Verlag GmbH Germany and ESICM. 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).

Idioma original	Anglès
Pàgines (de-a)	1820-1828
Revista	Intensive Care Medicine
Volum	43
Número	12
DOIs	https://doi.org/10.1007/s00134-017-4940-8
Estat de la publicació	Publicada - 1 de des. 2017

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10.1007/s00134-017-4940-8

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https://www.scopus.com/pages/publications/85029721289

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Flaatten, H., De Lange, D. W., Morandi, A., Andersen, F. H., Artigas, A., Bertolini, G., Boumendil, A., Cecconi, M., Christensen, S., Faraldi, L., Fjølner, J., Jung, C., Marsh, B., Moreno, R., Oeyen, S., Öhman, C. A., Pinto, B. B., Soliman, I. W., Szczeklik, W., ... Williams, P. (2017). The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (≥ 80 years). Intensive Care Medicine, 43(12), 1820-1828. https://doi.org/10.1007/s00134-017-4940-8

@article{d5a3107694304b169fcadc0988287d0f,

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

abstract = "{\textcopyright} 2017, Springer-Verlag GmbH Germany and ESICM. 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).",

keywords = "Elderly, Frailty, ICU, Mortality, Octogenarians, Severity of illness",

author = "Hans Flaatten and \{De Lange\}, \{Dylan W.\} and Alessandro Morandi and Andersen, \{Finn H.\} and Antonio Artigas and Guido Bertolini and Ariane Boumendil and Maurizio Cecconi and Steffen Christensen and Loredana Faraldi and Jesper Fj{\o}lner and Christian Jung and Brian Marsh and Rui Moreno and Sandra Oeyen and {\"O}hman, \{Christina Agwald\} and Pinto, \{Bernardo Bollen\} and Soliman, \{Ivo W.\} and Wojciech Szczeklik and Andreas Valentin and Ximena Watson and Tilemachos Zaferidis and Bertrand Guidet and Ren{\'e} Schmutz and Franz Wimmer and Philipp Eller and Klemens Zotter and Walter Swinnen and \{De Buysscher\}, Pieter and \{De Neve\}, Nikolaas and Paul Abraham and Yvan Fleury and Schefold, \{Joerg C.\} and Ewelina Biskup and Ioannis Taliadoros and Petr Piza and Alexander Lauten and Sacher, \{Anna Lena\} and Thorsten Brenner and Marcus Franz and Frank Bloos and Henning Ebelt and Schaller, \{Stefan J.\} and Kristina Fuest and Christian Rabe and Thorben Dieck and Stephan Steiner and Tobias Graf and Nia, \{Amir M.\} and Janosi, \{Rolf Alexander\} and Patrick Meybohm and Philipp Simon and Stefan Utzolino and Tim Rahmel and Eberhard Barth and Michael Schuster and Nilanjan Dey and Christoffer S{\o}lling and Rasmussen, \{Bodil Steen\} and Enver Rodriguez and Sergio Rebollo and Gerardo Aguilar and Gaspar Masdeu and Jaimes, \{Mari{\'a}n Iraz{\'a}bal\} and \{Prado Mira\}, {\'A}ngela and Bodi, \{Maria A.\} and \{Barea Mendoza\}, \{Jesus A.\} and Sonia L{\'o}pez-Cuenca and \{Homez Guzman\}, Marcela and Jes{\'u}s Rico-Feijoo and Mercedes Ibarz and Josep Trenado-Alvarez and Xavier Forceville and Guillaume Besch and Herve Mentec and Philippe Michel and Philippe Mateu and Lucie Vettoretti and Jeremy Bourenne and Nathalie Marin and Max Guillot and Naida Aissaoui and Cyril Goulenok and Nathalie Thieulot-Rolin and Jonathan Messika and Lionel Lamhaut and Cyril Charron and Ged Dempsey and Mathew, \{Shiju J.\} and Raj, \{Ashok S.\} and Irina Grecu and Jason Cupitt and Tom Lawton and Richard Clark and Monica Popescu and Nick Spittle and Maria Faulkner and Amanda Cowton and Esme Elloway and Patricia Williams",

year = "2017",

month = dec,

day = "1",

doi = "10.1007/s00134-017-4940-8",

language = "English",

volume = "43",

pages = "1820--1828",

journal = "Intensive Care Medicine",

issn = "0342-4642",

publisher = "Springer Science and Business Media Deutschland GmbH",

number = "12",

}

Flaatten, H, De Lange, DW, Morandi, A, Andersen, FH, Artigas, A, Bertolini, G, Boumendil, A, Cecconi, M, Christensen, S, Faraldi, L, Fjølner, J, Jung, C, Marsh, B, Moreno, R, Oeyen, S, Öhman, CA, Pinto, BB, Soliman, IW, Szczeklik, W, Valentin, A, Watson, X, Zaferidis, T, Guidet, B, Schmutz, R, Wimmer, F, Eller, P, Zotter, K, Swinnen, W, De Buysscher, P, De Neve, N, Abraham, P, Fleury, Y, Schefold, JC, Biskup, E, Taliadoros, I, Piza, P, Lauten, A, Sacher, AL, Brenner, T, Franz, M, Bloos, F, Ebelt, H, Schaller, SJ, Fuest, K, Rabe, C, Dieck, T, Steiner, S, Graf, T, Nia, AM, Janosi, RA, Meybohm, P, Simon, P, Utzolino, S, Rahmel, T, Barth, E, Schuster, M, Dey, N, Sølling, C, Rasmussen, BS, Rodriguez, E, Rebollo, S, Aguilar, G, Masdeu, G, Jaimes, MI, Prado Mira, Á, Bodi, MA, Barea Mendoza, JA, López-Cuenca, S, Homez Guzman, M, Rico-Feijoo, J, Ibarz, M, Trenado-Alvarez, J, Forceville, X, Besch, G, Mentec, H, Michel, P, Mateu, P, Vettoretti, L, Bourenne, J, Marin, N, Guillot, M, Aissaoui, N, Goulenok, C, Thieulot-Rolin, N, Messika, J, Lamhaut, L, Charron, C, Dempsey, G, Mathew, SJ, Raj, AS, Grecu, I, Cupitt, J, Lawton, T, Clark, R, Popescu, M, Spittle, N, Faulkner, M, Cowton, A, Elloway, E & Williams, P 2017, 'The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (≥ 80 years)', Intensive Care Medicine, vol. 43, núm. 12, pàg. 1820-1828. https://doi.org/10.1007/s00134-017-4940-8

TY - JOUR

T1 - The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (≥ 80 years)

AU - Flaatten, Hans

AU - De Lange, Dylan W.

AU - Morandi, Alessandro

AU - Andersen, Finn H.

AU - Artigas, Antonio

AU - Bertolini, Guido

AU - Boumendil, Ariane

AU - Cecconi, Maurizio

AU - Christensen, Steffen

AU - Faraldi, Loredana

AU - Fjølner, Jesper

AU - Jung, Christian

AU - Marsh, Brian

AU - Moreno, Rui

AU - Oeyen, Sandra

AU - Öhman, Christina Agwald

AU - Pinto, Bernardo Bollen

AU - Soliman, Ivo W.

AU - Szczeklik, Wojciech

AU - Valentin, Andreas

AU - Watson, Ximena

AU - Zaferidis, Tilemachos

AU - Guidet, Bertrand

AU - Schmutz, René

AU - Wimmer, Franz

AU - Eller, Philipp

AU - Zotter, Klemens

AU - Swinnen, Walter

AU - De Buysscher, Pieter

AU - De Neve, Nikolaas

AU - Abraham, Paul

AU - Fleury, Yvan

AU - Schefold, Joerg C.

AU - Biskup, Ewelina

AU - Taliadoros, Ioannis

AU - Piza, Petr

AU - Lauten, Alexander

AU - Sacher, Anna Lena

AU - Brenner, Thorsten

AU - Franz, Marcus

AU - Bloos, Frank

AU - Ebelt, Henning

AU - Schaller, Stefan J.

AU - Fuest, Kristina

AU - Rabe, Christian

AU - Dieck, Thorben

AU - Steiner, Stephan

AU - Graf, Tobias

AU - Nia, Amir M.

AU - Janosi, Rolf Alexander

AU - Meybohm, Patrick

AU - Simon, Philipp

AU - Utzolino, Stefan

AU - Rahmel, Tim

AU - Barth, Eberhard

AU - Schuster, Michael

AU - Dey, Nilanjan

AU - Sølling, Christoffer

AU - Rasmussen, Bodil Steen

AU - Rodriguez, Enver

AU - Rebollo, Sergio

AU - Aguilar, Gerardo

AU - Masdeu, Gaspar

AU - Jaimes, Marián Irazábal

AU - Prado Mira, Ángela

AU - Bodi, Maria A.

AU - Barea Mendoza, Jesus A.

AU - López-Cuenca, Sonia

AU - Homez Guzman, Marcela

AU - Rico-Feijoo, Jesús

AU - Ibarz, Mercedes

AU - Trenado-Alvarez, Josep

AU - Forceville, Xavier

AU - Besch, Guillaume

AU - Mentec, Herve

AU - Michel, Philippe

AU - Mateu, Philippe

AU - Vettoretti, Lucie

AU - Bourenne, Jeremy

AU - Marin, Nathalie

AU - Guillot, Max

AU - Aissaoui, Naida

AU - Goulenok, Cyril

AU - Thieulot-Rolin, Nathalie

AU - Messika, Jonathan

AU - Lamhaut, Lionel

AU - Charron, Cyril

AU - Dempsey, Ged

AU - Mathew, Shiju J.

AU - Raj, Ashok S.

AU - Grecu, Irina

AU - Cupitt, Jason

AU - Lawton, Tom

AU - Clark, Richard

AU - Popescu, Monica

AU - Spittle, Nick

AU - Faulkner, Maria

AU - Cowton, Amanda

AU - Elloway, Esme

AU - Williams, Patricia

PY - 2017/12/1

Y1 - 2017/12/1

N2 - © 2017, Springer-Verlag GmbH Germany and ESICM. 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).

AB - © 2017, Springer-Verlag GmbH Germany and ESICM. 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).

KW - Elderly

KW - Frailty

KW - ICU

KW - Mortality

KW - Octogenarians

KW - Severity of illness

UR - https://www.scopus.com/pages/publications/85029721289

U2 - 10.1007/s00134-017-4940-8

DO - 10.1007/s00134-017-4940-8

M3 - Article

SN - 0342-4642

VL - 43

SP - 1820

EP - 1828

JO - Intensive Care Medicine

JF - Intensive Care Medicine

IS - 12

ER -

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

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