Skip to main content

Advertisement

SpringerLink
Log in

Association of frailty with short-term outcomes, organ support and resource use in critically ill patients

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Purpose

Frail patients are known to experience poor outcomes. Nevertheless, we know less about how frailty manifests itself in patients’ physiology during critical illness and how it affects resource use in intensive care units (ICU). We aimed to assess the association of frailty with short-term outcomes and organ support used by critically ill patients.

Methods

Retrospective analysis of prospective collected data from 93 ICUs in Brazil from 2014 to 2015. We assessed frailty using the modified frailty index (MFI). The primary outcome was in-hospital mortality. Secondary outcomes were discharge home without need for nursing care, ICU and hospital length of stay (LOS), and utilization of ICU organ support and transfusion. We used mixed logistic regression and competing risk models accounting for relevant confounders in outcome analyses.

Results

The analysis consisted of 129,680 eligible patients. There were 40,779 (31.4%) non-frail (MFI = 0), 64,407 (49.7%) pre-frail (MFI = 1–2) and 24,494 (18.9%) frail (MFI ≥ 3) patients. After adjusted analysis, frailty was associated with higher in-hospital mortality (OR 2.42, 95% CI 1.89–3.08), particularly in patients admitted with lower SOFA scores. Frail patients were less likely to be discharged home (OR 0.36, 95% CI 0.54–0.79) and had higher hospital and ICU LOS than non-frail patients. Use of all forms of organ support (mechanical ventilation, non-invasive ventilation, vasopressors, dialysis and transfusions) were more common in frail patients and increased as MFI increased.

Conclusions

Frailty, as assessed by MFI, was associated with several patient-centered endpoints including not only survival, but also ICU LOS and organ support.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Fried LP, Tangen CM, Walston J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56:M146–M156

    Article  PubMed  CAS  Google Scholar 

  2. Farhat JS, Velanovich V, Falvo AJ et al (2012) Are the frail destined to fail? Frailty index as predictor of surgical morbidity and mortality in the elderly. J Trauma Acute Care Surg 72:1526–1530. https://doi.org/10.1097/ta.0b013e3182542fab (discussion 1530–1531)

    Article  PubMed  Google Scholar 

  3. Fried LP, Ferrucci L, Darer J et al (2004) Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 59:255–263

    Article  PubMed  Google Scholar 

  4. Muscedere J, Waters B, Varambally A et al (2017) The impact of frailty on intensive care unit outcomes: a systematic review and meta-analysis. Intensive Care Med 43:1105–1122. https://doi.org/10.1007/s00134-017-4867-0

    Article  PubMed  PubMed Central  Google Scholar 

  5. Le Maguet P, Roquilly A, Lasocki S et al (2014) Prevalence and impact of frailty on mortality in elderly ICU patients: a prospective, multicenter, observational study. Intensive Care Med 40:674–682. https://doi.org/10.1007/s00134-014-3253-4

    Article  PubMed  Google Scholar 

  6. Fisher C, Karalapillai DK, Bailey M et al (2015) Predicting intensive care and hospital outcome with the Dalhousie Clinical Frailty Scale: a pilot assessment. Anaesth Intensive Care 43:361–368

    PubMed  CAS  Google Scholar 

  7. Bagshaw SM, Stelfox HT, McDermid RC et al (2014) Association between frailty and short- and long-term outcomes among critically ill patients: a multicentre prospective cohort study. CMAJ Can Med Assoc J 186:E95–102. https://doi.org/10.1503/cmaj.130639

    Article  Google Scholar 

  8. Kizilarslanoglu MC, Civelek R, Kilic MK et al (2017) Is frailty a prognostic factor for critically ill elderly patients? Aging Clin Exp Res 29:247–255. https://doi.org/10.1007/s40520-016-0557-y

    Article  PubMed  Google Scholar 

  9. Mueller N, Murthy S, Tainter CR et al (2016) Can sarcopenia quantified by ultrasound of the rectus femoris muscle predict adverse outcome of surgical intensive care unit patients as well as frailty? A prospective, observational cohort study. Ann Surg 264:1116–1124. https://doi.org/10.1097/SLA.0000000000001546

    Article  PubMed  PubMed Central  Google Scholar 

  10. Brummel NE, Bell SP, Girard TD et al (2017) Frailty and subsequent disability and mortality among patients with critical illness. Am J Respir Crit Care Med 196:64–72. https://doi.org/10.1164/rccm.201605-0939OC

    Article  PubMed  PubMed Central  Google Scholar 

  11. Heyland DK, Garland A, Bagshaw SM et al (2015) Recovery after critical illness in patients aged 80 years or older: a multi-center prospective observational cohort study. Intensive Care Med 41:1911–1920. https://doi.org/10.1007/s00134-015-4028-2

    Article  PubMed  Google Scholar 

  12. Langlais E, Nesseler N, Le Pabic E et al (2018) Does the clinical frailty score improve the accuracy of the SOFA score in predicting hospital mortality in elderly critically ill patients? A prospective observational study. J Crit Care 46:67–72. https://doi.org/10.1016/j.jcrc.2018.04.012

    Article  PubMed  Google Scholar 

  13. Ferrante LE, Pisani MA, Murphy TE et al (2018) The association of frailty with post-ICU disability, nursing home admission, and mortality: a longitudinal study. Chest. https://doi.org/10.1016/j.chest.2018.03.007

    Article  PubMed  Google Scholar 

  14. Flaatten H, De Lange DW, Morandi A et al (2017) The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (≥ 80 years). Intensive Care Med 43:1820–1828. https://doi.org/10.1007/s00134-017-4940-8

    Article  PubMed  Google Scholar 

  15. Moreno RP, Metnitz PGH, Almeida E et al (2005) SAPS 3–from evaluation of the patient to evaluation of the intensive care unit. Part 2: development of a prognostic model for hospital mortality at ICU admission. Intensive Care Med 31:1345–1355. https://doi.org/10.1007/s00134-005-2763-5

    Article  PubMed  PubMed Central  Google Scholar 

  16. Zampieri FG, Soares M, Borges LP et al (2017) The Epimed Monitor ICU Database®: a cloud-based national registry for adult intensive care unit patients in Brazil. Rev Bras Ter Intensiva. https://doi.org/10.5935/0103-507X.20170062

    Article  PubMed  PubMed Central  Google Scholar 

  17. Vincent JL, Moreno R, Takala J et al (1996) The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710

    Article  PubMed  CAS  Google Scholar 

  18. Zampieri FG, Bozza FA, Moralez GM et al (2017) The effects of performance status one week before hospital admission on the outcomes of critically ill patients. Intensive Care Med 43:39–47. https://doi.org/10.1007/s00134-016-4563-5

    Article  PubMed  Google Scholar 

  19. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  PubMed  CAS  Google Scholar 

  20. Wachal B, Johnson M, Burchell A et al (2017) Association of modified frailty index score with perioperative risk for patients undergoing total laryngectomy. JAMA Otolaryngol Head Neck Surg 143:818–823. https://doi.org/10.1001/jamaoto.2017.0412

    Article  PubMed  PubMed Central  Google Scholar 

  21. Hall DE, Arya S, Schmid KK et al (2017) Development and initial validation of the risk analysis index for measuring frailty in surgical populations. JAMA Surg 152:175–182. https://doi.org/10.1001/jamasurg.2016.4202

    Article  PubMed  Google Scholar 

  22. Wahl TS, Graham LA, Hawn MT et al (2017) Association of the modified frailty index with 30-day surgical readmission. JAMA Surg 152:749–757. https://doi.org/10.1001/jamasurg.2017.1025

    Article  PubMed  PubMed Central  Google Scholar 

  23. Pearl JA, Patil D, Filson CP et al (2017) Patient frailty and discharge disposition following radical cystectomy. Clin Genitourin Cancer 15:e615–e621. https://doi.org/10.1016/j.clgc.2016.12.013

    Article  PubMed  Google Scholar 

  24. Vermillion SA, Hsu F-C, Dorrell RD et al (2017) Modified frailty index predicts postoperative outcomes in older gastrointestinal cancer patients. J Surg Oncol 115:997–1003. https://doi.org/10.1002/jso.24617

    Article  PubMed  Google Scholar 

  25. van Buuren R (2010) mice: multivariate imputation by chained equations in R. J Stat Softw. https://doi.org/10.18637/jss.v045.i03

    Article  Google Scholar 

  26. Venables WN, Ripley BD (2002) Modern applied statistics with S, 4th edn. Springer, New York

    Book  Google Scholar 

  27. R: the R project for statistical computing. https://www.r-project.org/. Accessed 8 Jun 2018

  28. Hope AA, Gong MN, Guerra C, Wunsch H (2015) Frailty before critical illness and mortality for elderly medicare beneficiaries. J Am Geriatr Soc 63:1121–1128. https://doi.org/10.1111/jgs.13436

    Article  PubMed  PubMed Central  Google Scholar 

  29. Mogal H, Vermilion SA, Dodson R et al (2017) Modified frailty index predicts morbidity and mortality after pancreaticoduodenectomy. Ann Surg Oncol 24:1714–1721. https://doi.org/10.1245/s10434-016-5715-0

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by the National Council for Scientific and Technological Development (CNPq), Carlos Chagas Filho Foundation for Research Support of the State of Rio de Janeiro (FAPERJ) and by departmental funds from the D’Or Institute for Research and Education. We dedicate this work to the memory of Dr. Lígia Sarmet Farah Cunha Rabello, ORCHESTRA Study investigator, who recently passed away.

Author information

Authors and Affiliations

  1. Research Institute, HCor-Hospital do Coração, São Paulo, Brazil

    Fernando G. Zampieri

  2. Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA

    Theodore J. Iwashyna & Elizabeth M. Viglianti

  3. Veterans Affairs Center for Clinical Management Research, HSR&D Center for Excellence, Ann Arbor, MI, USA

    Theodore J. Iwashyna

  4. ICU, Hospital Sírio Libanês, São Paulo, Brazil

    Leandro U. Taniguchi

  5. Emergency Medicine Discipline, Hospital das Clínicas HC-FMUSP, Universidade de São Paulo, São Paulo, Brazil

    Leandro U. Taniguchi

  6. ICU, Hospital Copa D’Or, Rio De Janeiro, Brazil

    William N. Viana

  7. ICU, Hospital Quinta D’Or, Rio De Janeiro, Brazil

    Roberto Costa

  8. Adult ICU, Hospital Israelita Albert Einstein, São Paulo, Brazil

    Thiago D. Corrêa

  9. ICU, Hospital Nove de Julho, São Paulo, Brazil

    Carlos Eduardo N. Moreira

  10. ICU, Hospital Santa Luzia Rede D’Or São Luiz DF, Brasília, Brazil

    Marcelo O. Maia

  11. Graduate Program in Translational Medicine and Department of Critical Care, D’Or Institute for Research and Education, Rio De Janeiro, Brazil

    Giulliana M. Moralez, Grazielle V. Ramos, Aline R. Silva, Fernando A. Bozza, Jorge. I. F. Salluh & Marcio Soares

  12. ICU, Hospital Santa Rita, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil

    Thiago Lisboa

  13. ICU, Hospital São Francisco, Ribeirão Preto, Brazil

    Marcus A. Ferez

  14. ICU, Hospital Esperança Olinda, Olinda, Brazil

    Carlos Eduardo F. Freitas

  15. ICU, Hospital Brasília, Brasília, Brazil

    Clayton B. de Carvalho

  16. ICU, Hospital Samaritano, São Paulo, Brazil

    Bruno F. Mazza

  17. ICU, Hospital Esperança, Recife, Brazil

    Mariza F. A. Lima

  18. ICU, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil

    Fernando G. Zampieri

  19. National Institute of Infectious Diseases Evandro Chagas, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil

    Fernando A. Bozza

Authors
  1. Fernando G. Zampieri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Theodore J. Iwashyna
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elizabeth M. Viglianti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Leandro U. Taniguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. William N. Viana
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Roberto Costa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Thiago D. Corrêa
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Carlos Eduardo N. Moreira
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Marcelo O. Maia
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Giulliana M. Moralez
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Thiago Lisboa
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Marcus A. Ferez
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Carlos Eduardo F. Freitas
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Clayton B. de Carvalho
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Bruno F. Mazza
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Mariza F. A. Lima
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Grazielle V. Ramos
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Aline R. Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Fernando A. Bozza
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Jorge. I. F. Salluh
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Marcio Soares
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

for the ORCHESTRA Study Investigators

Contributions

FGZ, TJI, EMV and MS participated in study conception, data interpretation, and drafting of the manuscript. FGZ performed the statistical analysis and produced the figures. FAB, JIFS and MS led data collection and cleaning. LUT, WNV, RC, TDC, CENM, MOM, GMM, TL, MAF, CEFF, CBC, BFM, MFAL, GVR, ARS, FAB and JIFS participated in data acquisition and revised the manuscript for important intellectual content. All authors approved the final copy of the manuscript.

Corresponding author

Correspondence to Marcio Soares.

Ethics declarations

Conflicts of interest

Dr. Soares and Dr. Salluh are founders and equity shareholders of Epimed Solutions®, which commercializes the Epimed Monitor System®, a cloud-based software for ICU management and benchmarking. The other authors declare that they have no conflict of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PDF 526 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zampieri, F.G., Iwashyna, T.J., Viglianti, E.M. et al. Association of frailty with short-term outcomes, organ support and resource use in critically ill patients. Intensive Care Med 44, 1512–1520 (2018). https://doi.org/10.1007/s00134-018-5342-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-018-5342-2

Keywords

Search

Navigation