Association between frailty and short- and long-term outcomes among critically ill patients: a multicentre prospective cohort study

Frailty is a multidimensional syndrome characterized by loss of physiologic and cognitive reserves that confers vulnerability to adverse outcomes. We determined the prevalence, correlates and outcomes associated with frailty among adults admitted to intensive care. We prospectively enrolled 421 crit...

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Vydané v:Canadian Medical Association journal (CMAJ) Ročník 186; číslo 2; s. E95 - E102
Hlavní autori: Bagshaw, Sean M., Stelfox, H. Thomas, McDermid, Robert C., Rolfson, Darryl B., Tsuyuki, Ross T., Baig, Nadia, Artiuch, Barbara, Ibrahim, Quazi, Stollery, Daniel E., Rokosh, Ella, Majumdar, Sumit R.
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: Canada Joule Inc 04.02.2014
CMA Impact, Inc
Canadian Medical Association
Predmet:
Aged
Care and treatment
Cohort Studies
Critical Illness
Critically ill
Elder care
Female
Frail Elderly
Frailty
Humans
Intensive care
Male
Medical prognosis
Medical research
Medicine, Experimental
Patients
Prognosis
Prospective Studies
Quality of life
Severity of Illness Index
Studies
Time Factors
Alberta Canada
Canada
ISSN:0820-3946, 1488-2329, 1488-2329
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Shrnutí:Frailty is a multidimensional syndrome characterized by loss of physiologic and cognitive reserves that confers vulnerability to adverse outcomes. We determined the prevalence, correlates and outcomes associated with frailty among adults admitted to intensive care. We prospectively enrolled 421 critically ill adults aged 50 or more at 6 hospitals across the province of Alberta. The primary exposure was frailty, defined by a score greater than 4 on the Clinical Frailty Scale. The primary outcome measure was in-hospital mortality. Secondary outcome measures included adverse events, 1-year mortality and quality of life. The prevalence of frailty was 32.8% (95% confidence interval [CI] 28.3%-37.5%). Frail patients were older, were more likely to be female, and had more comorbidities and greater functional dependence than those who were not frail. In-hospital mortality was higher among frail patients than among non-frail patients (32% v. 16%; adjusted odds ratio [OR] 1.81, 95% CI 1.09-3.01) and remained higher at 1 year (48% v. 25%; adjusted hazard ratio 1.82, 95% CI 1.28-2.60). Major adverse events were more common among frail patients (39% v. 29%; OR 1.54, 95% CI 1.01-2.37). Compared with nonfrail survivors, frail survivors were more likely to become functionally dependent (71% v. 52%; OR 2.25, 95% CI 1.03-4.89), had significantly lower quality of life and were more often readmitted to hospital (56% v. 39%; OR 1.98, 95% CI 1.22-3.23) in the 12 months following enrolment. Frailty was common among critically ill adults aged 50 and older and identified a population at increased risk of adverse events, morbidity and mortality. Diagnosis of frailty could improve prognostication and identify a vulnerable population that might benefit from follow-up and intervention.
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ISSN:0820-3946
1488-2329
1488-2329
DOI:10.1503/cmaj.130639