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

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137 Citations (Scopus)

Abstract

© 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).
Original languageEnglish
Pages (from-to)1820-1828
JournalIntensive Care Medicine
Volume43
Issue number12
DOIs
Publication statusPublished - 1 Dec 2017

Keywords

  • Elderly
  • Frailty
  • ICU
  • Mortality
  • Octogenarians
  • Severity of illness

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