Clinical Frailty Scale (CFS) reliably stratifies octogenarians in German ICUs: a multicentre prospective cohort study

doi:10.1186/s12877-018-0847-7

Multicenter Study

. 2018 Jul 13;18(1):162.

doi: 10.1186/s12877-018-0847-7.

Clinical Frailty Scale (CFS) reliably stratifies octogenarians in German ICUs: a multicentre prospective cohort study

Johanna M Muessig¹, Amir M Nia², Maryna Masyuk¹, Alexander Lauten^{3

4}, Anne Lena Sacher⁵, Thorsten Brenner⁶, Marcus Franz⁷, Frank Bloos⁸, Henning Ebelt⁹, Stefan J Schaller¹⁰, Kristina Fuest¹⁰, Christian Rabe¹¹, Thorben Dieck¹², Stephan Steiner¹³, Tobias Graf^{14

15}, Rolf A Jánosi¹⁶, Patrick Meybohm¹⁷, Philipp Simon¹⁸, Stefan Utzolino¹⁹, Tim Rahmel²⁰, Eberhard Barth²¹, Michael Schuster²², Malte Kelm^{1

23}, Christian Jung¹

Affiliations

¹ Division of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
² Division of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany. amir.nia@med.uni-duesseldorf.de.
³ Department of Cardiology, Charité - University Hospital, Berlin, Germany.
⁴ German Center for Heart Research (DZHK), Berlin, Germany.
⁵ Department of Anaesthesiology and Operative Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany.
⁶ Department of Anaesthesiology, Heidelberg University Hospital, Heidelberg, Germany.
⁷ Department of Internal Medicine I, Friedrich-Schiller-University, University Hospital Jena, Jena, Germany.
⁸ Department of Anaesthesiology and Intensive Care Medicine, University Hospital Jena, Jena, Germany.
⁹ Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Erfurt, Germany.
¹⁰ Department of Anaesthesiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
¹¹ Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
¹² Department of Anaesthesiology and Intensive Care, Hannover Medical School, Hannover, Germany.
¹³ St. Vincenz Hospital, Department of Cardiology, Pneumology and Intensive Care Medicine, Limburg/Lahn, Limburg, Germany.
¹⁴ University Heart Center Luebeck, Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital Schleswig-Holstein, Luebeck, Germany.
¹⁵ German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Luebeck, Germany.
¹⁶ Medical Faculty, West German Heart and Vascular Center, Department of Cardiology and Vascular Diseases, University Hospital Essen, Essen, Germany.
¹⁷ Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt/Main, Germany.
¹⁸ Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Leipzig, Germany.
¹⁹ Department of General and Visceral Surgery, University Hospital Freiburg, Freiburg, Germany.
²⁰ Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany.
²¹ Division of Intensive Care Medicine, Department of Anaesthesiology, University Hospital Ulm, Ulm, Germany.
²² Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Mainz, Mainz, Germany.
²³ CARID, Cardiovascular Research Institute Düsseldorf, Düsseldorf, Germany.

PMID: 30005622
PMCID: PMC6044022
DOI: 10.1186/s12877-018-0847-7

Multicenter Study

Clinical Frailty Scale (CFS) reliably stratifies octogenarians in German ICUs: a multicentre prospective cohort study

Johanna M Muessig et al. BMC Geriatr. 2018.

. 2018 Jul 13;18(1):162.

doi: 10.1186/s12877-018-0847-7.

Authors

Affiliations

¹ Division of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
² Division of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany. amir.nia@med.uni-duesseldorf.de.
³ Department of Cardiology, Charité - University Hospital, Berlin, Germany.
⁴ German Center for Heart Research (DZHK), Berlin, Germany.
⁵ Department of Anaesthesiology and Operative Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany.
⁶ Department of Anaesthesiology, Heidelberg University Hospital, Heidelberg, Germany.
⁷ Department of Internal Medicine I, Friedrich-Schiller-University, University Hospital Jena, Jena, Germany.
⁸ Department of Anaesthesiology and Intensive Care Medicine, University Hospital Jena, Jena, Germany.
⁹ Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Erfurt, Germany.
¹⁰ Department of Anaesthesiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
¹¹ Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
¹² Department of Anaesthesiology and Intensive Care, Hannover Medical School, Hannover, Germany.
¹³ St. Vincenz Hospital, Department of Cardiology, Pneumology and Intensive Care Medicine, Limburg/Lahn, Limburg, Germany.
¹⁴ University Heart Center Luebeck, Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital Schleswig-Holstein, Luebeck, Germany.
¹⁵ German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Luebeck, Germany.
¹⁶ Medical Faculty, West German Heart and Vascular Center, Department of Cardiology and Vascular Diseases, University Hospital Essen, Essen, Germany.
¹⁷ Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt/Main, Germany.
¹⁸ Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Leipzig, Germany.
¹⁹ Department of General and Visceral Surgery, University Hospital Freiburg, Freiburg, Germany.
²⁰ Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany.
²¹ Division of Intensive Care Medicine, Department of Anaesthesiology, University Hospital Ulm, Ulm, Germany.
²² Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Mainz, Mainz, Germany.
²³ CARID, Cardiovascular Research Institute Düsseldorf, Düsseldorf, Germany.

PMID: 30005622
PMCID: PMC6044022
DOI: 10.1186/s12877-018-0847-7

Abstract

Background: In intensive care units (ICU) octogenarians become a routine patients group with aggravated therapeutic and diagnostic decision-making. Due to increased mortality and a reduced quality of life in this high-risk population, medical decision-making a fortiori requires an optimum of risk stratification. Recently, the VIP-1 trial prospectively observed that the clinical frailty scale (CFS) performed well in ICU patients in overall-survival and short-term outcome prediction. However, it is known that healthcare systems differ in the 21 countries contributing to the VIP-1 trial. Hence, our main focus was to investigate whether the CFS is usable for risk stratification in octogenarians admitted to diversified and high tech German ICUs.

Methods: This multicentre prospective cohort study analyses very old patients admitted to 20 German ICUs as a sub-analysis of the VIP-1 trial. Three hundred and eight patients of 80 years of age or older admitted consecutively to participating ICUs. CFS, cause of admission, APACHE II, SAPS II and SOFA scores, use of ICU resources and ICU- and 30-day mortality were recorded. Multivariate logistic regression analysis was used to identify factors associated with 30-day mortality.

Results: Patients had a median age of 84 [IQR 82-87] years and a mean CFS of 4.75 (± 1.6 standard-deviation) points. More than half of the patients (53.6%) were classified as frail (CFS ≥ 5). ICU-mortality was 17.3% and 30-day mortality was 31.2%. The cause of admission (planned vs. unplanned), (OR 5.74) and the CFS (OR 1.44 per point increase) were independent predictors of 30-day survival.

Conclusions: The CFS is an easy determinable valuable tool for prediction of 30-day ICU survival in octogenarians, thus, it may facilitate decision-making for intensive care givers in Germany.

Trial registration: The VIP-1 study was retrospectively registered on ClinicalTrials.gov (ID: NCT03134807 ) on May 1, 2017.

Keywords: Clinical frailty scale; Frailty; Intensive care outcome; VIP1.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

Ethical approval was obtained from each study side with Duesseldorf (Ethic Committee of Medical Faculty of Heinrich-Heine University Duesseldorf, Germany; Head: Prof. Dr. T. Hohlfeld; study-number: 5644R and registration-ID: 2016075289 approved on 16th September 2016) being the national headquarter for all german ethic committees (Additional file 1: ethics committees). Written informed consent was obtained from all patients.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

**Fig. 1**
Participating ICUs. Participating ICUs are marked. The number of enclosed patients is indicated for each participating ICU

**Fig. 2**
Association of the Clinical Frailty Scale with 30-day mortality in acute admitted patients. Distribution of frailty in acute and elective admitted Patients (a). Association of frailty with 30-day mortality (b). Patients were divided into three groups according to their frailty status: fit (CFS 1–3), pre-frail (CFS 4) and frail (CFS 5–9). CFS: Clinical Frailty Score ranging from 1 (not frail) to 9 (terminally ill)

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References

1. Baldwin MR, Reid MC, Westlake AA, Rowe JW, Granieri EC, Wunsch H, Dam TT, Rabinowitz D, Goldstein NE, Maurer MS, et al. The feasibility of measuring frailty to predict disability and mortality in older medical intensive care unit survivors. J Crit Care. 2014;29(3):401–408. doi: 10.1016/j.jcrc.2013.12.019. - DOI - PMC - PubMed
1. Muessig JM, Masyuk M, Nia AM, Franz M, Kabisch B, Kelm M, Jung C. Are we ever too old?: characteristics and outcome of octogenarians admitted to a medical intensive care unit. Medicine (Baltimore) 2017;96(37):e7776. doi: 10.1097/MD.0000000000007776. - DOI - PMC - PubMed
1. Flaatten H, de Lange DW, Artigas A, Bin D, Moreno R, Christensen S, Joynt GM, Bagshaw SM, Sprung CL, Benoit D, et al. The status of intensive care medicine research and a future agenda for very old patients in the ICU. Intensive Care Med. 2017;43(9):1319–28. - PubMed
1. Flaatten H, De Lange DW, Morandi A, Andersen FH, Artigas A, Bertolini G, Boumendil A, Cecconi M, Christensen S, Faraldi L, et al. The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (>/= 80 years). Intensive Care Med. 2017;43(12):1820–8. - PubMed
1. Andersen FH, Flaatten H, Klepstad P, Follestad T, Strand K, Kruger AJ, Hahn M, Buskop C, Rime AK, Kvale R. Long-term outcomes after ICU admission triage in octogenarians. Crit Care Med. 2017;45(4):e363–e371. doi: 10.1097/CCM.0000000000002098. - DOI - PubMed

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[1] Baldwin MR, Reid MC, Westlake AA, Rowe JW, Granieri EC, Wunsch H, Dam TT, Rabinowitz D, Goldstein NE, Maurer MS, et al. The feasibility of measuring frailty to predict disability and mortality in older medical intensive care unit survivors. J Crit Care. 2014;29(3):401–408. doi: 10.1016/j.jcrc.2013.12.019. - DOI - PMC - PubMed

[2] Baldwin MR, Reid MC, Westlake AA, Rowe JW, Granieri EC, Wunsch H, Dam TT, Rabinowitz D, Goldstein NE, Maurer MS, et al. The feasibility of measuring frailty to predict disability and mortality in older medical intensive care unit survivors. J Crit Care. 2014;29(3):401–408. doi: 10.1016/j.jcrc.2013.12.019. - DOI - PMC - PubMed

[3] Muessig JM, Masyuk M, Nia AM, Franz M, Kabisch B, Kelm M, Jung C. Are we ever too old?: characteristics and outcome of octogenarians admitted to a medical intensive care unit. Medicine (Baltimore) 2017;96(37):e7776. doi: 10.1097/MD.0000000000007776. - DOI - PMC - PubMed

[4] Muessig JM, Masyuk M, Nia AM, Franz M, Kabisch B, Kelm M, Jung C. Are we ever too old?: characteristics and outcome of octogenarians admitted to a medical intensive care unit. Medicine (Baltimore) 2017;96(37):e7776. doi: 10.1097/MD.0000000000007776. - DOI - PMC - PubMed

[5] Flaatten H, de Lange DW, Artigas A, Bin D, Moreno R, Christensen S, Joynt GM, Bagshaw SM, Sprung CL, Benoit D, et al. The status of intensive care medicine research and a future agenda for very old patients in the ICU. Intensive Care Med. 2017;43(9):1319–28. - PubMed

[6] Flaatten H, de Lange DW, Artigas A, Bin D, Moreno R, Christensen S, Joynt GM, Bagshaw SM, Sprung CL, Benoit D, et al. The status of intensive care medicine research and a future agenda for very old patients in the ICU. Intensive Care Med. 2017;43(9):1319–28. - PubMed

[7] Flaatten H, De Lange DW, Morandi A, Andersen FH, Artigas A, Bertolini G, Boumendil A, Cecconi M, Christensen S, Faraldi L, et al. The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (>/= 80 years). Intensive Care Med. 2017;43(12):1820–8. - PubMed

[8] Flaatten H, De Lange DW, Morandi A, Andersen FH, Artigas A, Bertolini G, Boumendil A, Cecconi M, Christensen S, Faraldi L, et al. The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (>/= 80 years). Intensive Care Med. 2017;43(12):1820–8. - PubMed

[9] Andersen FH, Flaatten H, Klepstad P, Follestad T, Strand K, Kruger AJ, Hahn M, Buskop C, Rime AK, Kvale R. Long-term outcomes after ICU admission triage in octogenarians. Crit Care Med. 2017;45(4):e363–e371. doi: 10.1097/CCM.0000000000002098. - DOI - PubMed

[10] Andersen FH, Flaatten H, Klepstad P, Follestad T, Strand K, Kruger AJ, Hahn M, Buskop C, Rime AK, Kvale R. Long-term outcomes after ICU admission triage in octogenarians. Crit Care Med. 2017;45(4):e363–e371. doi: 10.1097/CCM.0000000000002098. - DOI - PubMed

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Clinical Frailty Scale (CFS) reliably stratifies octogenarians in German ICUs: a multicentre prospective cohort study

Affiliations

Clinical Frailty Scale (CFS) reliably stratifies octogenarians in German ICUs: a multicentre prospective cohort study

Authors

Affiliations

Abstract

Conflict of interest statement

Ethics approval and consent to participate

Consent for publication

Competing interests

Publisher’s Note

Figures

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Cited by

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Abstract

Conflict of interest statement

Ethics approval and consent to participate

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