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

doi:10.1007/s00134-017-4940-8

. 2017 Dec;43(12):1820-1828.

doi: 10.1007/s00134-017-4940-8. Epub 2017 Sep 21.

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

Hans Flaatten^{1

2}, Dylan W De Lange³, Alessandro Morandi^{4

5}, Finn H Andersen^{6

7}, Antonio Artigas⁸, Guido Bertolini⁹, Ariane Boumendil¹⁰, Maurizio Cecconi¹¹, Steffen Christensen¹², Loredana Faraldi¹³, Jesper Fjølner¹², Christian Jung¹⁴, Brian Marsh¹⁵, Rui Moreno¹⁶, Sandra Oeyen¹⁷, Christina Agwald Öhman¹⁸, Bernardo Bollen Pinto¹⁹, Ivo W Soliman²⁰, Wojciech Szczeklik²¹, Andreas Valentin²², Ximena Watson¹¹, Tilemachos Zaferidis²³, Bertrand Guidet^{24

25

26}; VIP1 study group

Affiliations

¹ Department of Clinical Medicine, University of Bergen, Bergen, Norway. hans.flaatten@uib.no.
² Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway. hans.flaatten@uib.no.
³ Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands.
⁴ Department of Rehabilitation Hospital Ancelle di Cremona, Cremona, Italy.
⁵ Geriatric Research Group, Brescia, Italy.
⁶ Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway.
⁷ Department of Circulation and Medical Imaging, NTNU, Trondheim, Norway.
⁸ Department of Intensive Care Medecine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain.
⁹ Laboratorio di Epidemiologia Clinica, Centro di Coordinamento GiViTI Dipar timento di Salute Pubblica, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Villa Camozzi, 24020, Ranica (Bergamo), Italy.
¹⁰ Unite de Recherche en Epidemiologie Systemes d'Information et Mode lisation U707, Institut national de la sante et de la recherche medicale, Paris, France.
¹¹ St George's University Hospital, London, UK.
¹² Department of Anaesthesia and Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark.
¹³ Grande Ospedale Metropolitano Niguarda, Milan, Italy.
¹⁴ Department of Cardiology, Pulmonology and Angiology, University Hospital, Düsseldorf, Germany.
¹⁵ Mater Misericordiae University Hospital, Dublin, Ireland.
¹⁶ Unidade de Cuidados Intensivos Neurocríticos, Hospital de São José, Centro Hospitalar de Lisboa Central, Faculdade de Ciência Médicas de Lisboa, Nova Médical School, Lisbon, Portugal.
¹⁷ Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium.
¹⁸ Karolinska University Hospital, Solna, Sweden.
¹⁹ Geneva University Hospitals, Geneva, Switzerland.
²⁰ Department of Intensive Care, University Medical Center, University Utrecht, Utrecht, The Netherlands.
²¹ Intensive Care and Perioperative Medicine Division, Jagiellonian University Medical College, Kraków, Poland.
²² Kardinal Schwarzenberg Hospital, Schwarzach, Austria.
²³ Intensive Care Unit General Hospital of Larissa Tsakalof, Larissa, Greece.
²⁴ Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, Paris, France.
²⁵ Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.
²⁶ INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.

PMID: 28936626
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 et al. Intensive Care Med. 2017 Dec.

. 2017 Dec;43(12):1820-1828.

doi: 10.1007/s00134-017-4940-8. Epub 2017 Sep 21.

Authors

Affiliations

¹ Department of Clinical Medicine, University of Bergen, Bergen, Norway. hans.flaatten@uib.no.
² Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway. hans.flaatten@uib.no.
³ Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands.
⁴ Department of Rehabilitation Hospital Ancelle di Cremona, Cremona, Italy.
⁵ Geriatric Research Group, Brescia, Italy.
⁶ Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway.
⁷ Department of Circulation and Medical Imaging, NTNU, Trondheim, Norway.
⁸ Department of Intensive Care Medecine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain.
⁹ Laboratorio di Epidemiologia Clinica, Centro di Coordinamento GiViTI Dipar timento di Salute Pubblica, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Villa Camozzi, 24020, Ranica (Bergamo), Italy.
¹⁰ Unite de Recherche en Epidemiologie Systemes d'Information et Mode lisation U707, Institut national de la sante et de la recherche medicale, Paris, France.
¹¹ St George's University Hospital, London, UK.
¹² Department of Anaesthesia and Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark.
¹³ Grande Ospedale Metropolitano Niguarda, Milan, Italy.
¹⁴ Department of Cardiology, Pulmonology and Angiology, University Hospital, Düsseldorf, Germany.
¹⁵ Mater Misericordiae University Hospital, Dublin, Ireland.
¹⁶ Unidade de Cuidados Intensivos Neurocríticos, Hospital de São José, Centro Hospitalar de Lisboa Central, Faculdade de Ciência Médicas de Lisboa, Nova Médical School, Lisbon, Portugal.
¹⁷ Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium.
¹⁸ Karolinska University Hospital, Solna, Sweden.
¹⁹ Geneva University Hospitals, Geneva, Switzerland.
²⁰ Department of Intensive Care, University Medical Center, University Utrecht, Utrecht, The Netherlands.
²¹ Intensive Care and Perioperative Medicine Division, Jagiellonian University Medical College, Kraków, Poland.
²² Kardinal Schwarzenberg Hospital, Schwarzach, Austria.
²³ Intensive Care Unit General Hospital of Larissa Tsakalof, Larissa, Greece.
²⁴ Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, Paris, France.
²⁵ Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.
²⁶ INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.

PMID: 28936626
DOI: 10.1007/s00134-017-4940-8

Abstract

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.

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Comment in

Is this critically ill patient elderly or too old?
Robert R, Skrifvars MB, Ranzani OT. Robert R, et al. Intensive Care Med. 2017 Dec;43(12):1884-1886. doi: 10.1007/s00134-017-4965-z. Epub 2017 Oct 26. Intensive Care Med. 2017. PMID: 29075802 No abstract available.
Frailty in the age of VIPs (very old intensive care patients).
Montgomery C, Bagshaw SM. Montgomery C, et al. Intensive Care Med. 2017 Dec;43(12):1887-1888. doi: 10.1007/s00134-017-4974-y. Epub 2017 Oct 30. Intensive Care Med. 2017. PMID: 29085974 No abstract available.

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Todi S, Choudhuri R. Todi S, et al. Indian J Crit Care Med. 2020 Jul;24(7):500-501. doi: 10.5005/jp-journals-10071-23492. Indian J Crit Care Med. 2020. PMID: 32963428 Free PMC article.
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References

1. Crit Care. 2010;14(1):R2 - PubMed
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1. Acta Anaesthesiol Scand. 2014 Jan;58(1):19-26 - PubMed
1. Minerva Anestesiol. 2017 Jun 14;:null - PubMed
1. Intensive Care Med. 2017 Aug;43(8):1105-1122 - PubMed

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[1] Crit Care. 2010;14(1):R2 - PubMed

[2] Crit Care. 2010;14(1):R2 - PubMed

[3] Crit Care Resusc. 2013 Mar;15(1):49-55 - PubMed

[4] Crit Care Resusc. 2013 Mar;15(1):49-55 - PubMed

[5] Acta Anaesthesiol Scand. 2014 Jan;58(1):19-26 - PubMed

[6] Acta Anaesthesiol Scand. 2014 Jan;58(1):19-26 - PubMed

[7] Minerva Anestesiol. 2017 Jun 14;:null - PubMed

[8] Minerva Anestesiol. 2017 Jun 14;:null - PubMed

[9] Intensive Care Med. 2017 Aug;43(8):1105-1122 - PubMed

[10] Intensive Care Med. 2017 Aug;43(8):1105-1122 - PubMed

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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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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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