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Multicenter Study
. 2021 Feb 25;25(1):84.
doi: 10.1186/s13054-021-03510-y.

Frailty status among older critically ill patients with severe acute kidney injury

William Beaubien-Souligny  1 , Alan Yang  2 , Gerald Lebovic  2 , Ron Wald  3 , Sean M Bagshaw  4
Affiliations
Multicenter Study

Frailty status among older critically ill patients with severe acute kidney injury

William Beaubien-Souligny et al. Crit Care. .

Abstract

Background: Frailty status among critically ill patients with acute kidney injury (AKI) is not well described despite its importance for prognostication and informed decision-making on life-sustaining therapies. In this study, we aim to describe the epidemiology of frailty in a cohort of older critically ill patients with severe AKI, the outcomes of patients with pre-existing frailty before AKI and the factors associated with a worsening frailty status among survivors.

Methods: This was a secondary analysis of a prospective multicentre observational study that enrolled older (age > 65 years) critically ill patients with AKI. The clinical frailty scale (CFS) score was captured at baseline, at 6 months and at 12 months among survivors. Frailty was defined as a CFS score of ≥ 5. Demographic, clinical and physiological variables associated with frailty as baseline were described. Multivariable Cox proportional hazard models were constructed to describe the association between frailty and 90-day mortality. Demographic and clinical factors associated with worsening frailty status at 6 months and 12 months were described using multivariable logistic regression analysis and multistate models.

Results: Among the 462 patients in our cohort, median (IQR) baseline CFS score was 4 (3-5), with 141 (31%) patients considered frail. Pre-existing frailty was associated with greater hazard of 90-day mortality (59% (n = 83) for frail vs. 31% (n = 100) for non-frail; adjusted hazards ratio [HR] 1.49; 95% CI 1.11-2.01, p = 0.008). At 6 months, 68 patients (28% of survivors) were frail. Of these, 57% (n = 39) were not classified as frail at baseline. Between 6 and 12 months of follow-up, 9 (4% of survivors) patients transitioned from a frail to a not frail status while 10 (4% of survivors) patients became frail and 11 (5% of survivors) patients died. In multivariable analysis, age was independently associated with worsening CFS score from baseline to 6 months (adjusted odds ratio [OR] 1.08; 95% CI 1.03-1.13, p = 0.003).

Conclusions: Pre-existing frailty is an independent risk factor for mortality among older critically ill patients with severe AKI. A substantial proportion of survivors experience declining function and worsened frailty status within one year.

Keywords: Acute kidney injury; Aging; Frailty; Functional status; Patient-oriented outcomes; Quality of life; Renal replacement therapy.

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Conflict of interest statement

RW has received unrestricted research funding and speaker fees from Baxter.

Figures

Fig. 1
Fig. 1
Sankey diagram showing frailty status in 462 patients with available CFS score at baseline in the OPTIMAL-AKI cohort. Links in pink are proportional to the number of patients transitioning to a frail status
Fig. 2
Fig. 2
Kaplan–Meier survival curves stratified by baseline frailty status in the OPTIMAL-AKI cohort study. a Stratified by binary classification of frail (clinical frailty scale (CFS): 5–8) or not frail (CFS: 1–4). b Stratified by categorical classification of frailty status defined as fit (CFS: 1–3), vulnerable (CFS: 4), mild frailty (CFS: 5–6) and moderate-to-severe frailty (CFS: 7–8)
See this image and copyright information in PMC

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