Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2021 Jul 1;25(1):231.
doi: 10.1186/s13054-021-03632-3.

Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study

Jakub Fronczek  1 , Kamil Polok  1 , Dylan W de Lange  2 , Christian Jung  3 , Michael Beil  4 , Andrew Rhodes  5 , Jesper Fjølner  6 , Jacek Górka  1 , Finn H Andersen  7   8 , Antonio Artigas  9 , Maurizio Cecconi  10   11 , Steffen Christensen  6 , Michael Joannidis  12 , Susannah Leaver  13 , Brian Marsh  14 , Alessandro Morandi  15 , Rui Moreno  16 , Sandra Oeyen  17 , Christina Agvald-Öhman  18 , Bernardo Bollen Pinto  19 , Joerg C Schefold  20 , Andreas Valentin  21 , Sten Walther  22 , Ximena Watson  5 , Tilemachos Zafeiridis  23 , Sigal Sviri  24 , Peter Vernon van Heerden  25 , Hans Flaatten  26   27 , Bertrand Guidet  28 , Wojciech Szczeklik  29 ; VIP1; VIP2 study group
Collaborators, Affiliations
Multicenter Study

Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study

Jakub Fronczek et al. Crit Care. .

Abstract

Background: The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context.

Methods: We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients ≥ 80 years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patient's age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score.

Results: The median age in the sample of 7487 consecutive patients was 84 years (IQR 81-87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p < 0.001). The relationship between the CFS score and mortality was nonlinear (p < 0.01).

Conclusion: Knowledge about a patient's frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided. Trial registration NCT03134807 (VIP1), NCT03370692 (VIP2).

Keywords: Aged, 80 and over; Frailty; Intensive care units; Mortality; Prospective studies.

PubMed Disclaimer

Conflict of interest statement

Joerg C. Schefold declares that the Dept. of Intensive Care Medicine Bern has/had research and/or development/consulting contracts with (full disclosure): Orion Corporation, Abbott Nutrition International, B. Braun Medical AG, CSEM SA, Edwards Lifesciences Services GmbH/SA, Kenta Biotech Ltd, Maquet Critical Care AB, Omnicare Clinical Research AG, and Nestlé. Educational grants were received from Fresenius Kabi; GSK; MSD; Lilly; Baxter; Astellas; AstraZeneca; B. Braun Medical AG, CSL Behring, Maquet, Novartis, Covidien, Nycomed, Pierre Fabre Pharma (Roba Pharma); Pfizer, Orion Pharma. The money went into departmental funds. No personal financial gain applies. All other authors do not have any conflict of interest to declare related to this manuscript.

Figures

Fig. 1
Fig. 1
The impact of modelling approach on the association between frailty and short-term mortality. Simplified grouping used CFS < 4 as a reference, with vulnerability defined as a CFS = 4 and frailty as a CFS ≥ 5; CFS = 1 was used as a reference in the three other modelling approaches shown in the figure. Odds ratios obtained after dichotomisation of the CFS score are described in the text. The relationship between the CFS score and mortality was nonlinear in both models (p values < 0.01). Adjusted for age, sex, reason for admission to the ICU, and admission SOFA score
Fig. 2
Fig. 2
The impact of modelling approach on the model-calculated risk of death. Adjusted probabilities displayed for an 84-year-old male admitted due to respiratory reasons with a SOFA score equal to 7
See this image and copyright information in PMC

References

    1. Flaatten H, de Lange DW, Artigas A, Bin D, Moreno R, Christensen S, et al. The status of intensive care medicine research and a future agenda for very old patients in the ICU. Intensive Care Med. 2017;43:1319–1328. doi: 10.1007/s00134-017-4718-z. - DOI - PubMed
    1. Nguyen Y-L, Angus DC, Boumendil A, Guidet B. The challenge of admitting the very elderly to intensive care. Ann Intensive Care. 2011;1:29. doi: 10.1186/2110-5820-1-29. - DOI - PMC - PubMed
    1. Stelfox HT, Hemmelgarn BR, Bagshaw SM, Gao S, Doig CJ, Nijssen-Jordan C, et al. Intensive Care Unit bed availability and outcomes for hospitalized patients with sudden clinical deterioration. Arch Intern Med. 2012;172:467–474. doi: 10.1001/archinternmed.2011.2315. - DOI - PubMed
    1. Simchen E, Sprung CL, Galai N, Zitser-Gurevich Y, Bar-Lavi Y, Gurman G, et al. Survival of critically ill patients hospitalized in and out of intensive care units under paucity of intensive care unit beds. Crit Care Med. 2004;32:1654–1661. doi: 10.1097/01.CCM.0000133021.22188.35. - DOI - PubMed
    1. Town JA, Churpek MM, Yuen TC, Huber MT, Kress JP, Edelson DP. Relationship between ICU bed availability, ICU readmission, and cardiac arrest in the general wards. Crit Care Med. 2014;42:2037–2041. doi: 10.1097/CCM.0000000000000401. - DOI - PMC - PubMed

Publication types

Associated data