Long-stay ICU patients with frailty: mortality and recovery outcomes at 6 months

Abstract

Background: Prolonged intensive care unit (ICU) stay is associated with physical, cognitive, and psychological disabilities. The impact of baseline frailty on long-stay ICU patients remains uncertain. This study aims to investigate how baseline frailty influences mortality and post-ICU disability 6 months after critical illness in long-stay ICU patients.

Methods: In this retrospective cohort study, we assessed patients hospitalized for ≥ 7 days in the ICU between May 2018 and May 2021, following them for up to 6 months or until death. Based on the Clinical Frailty Scale (CFS) at ICU admissions, patients were categorized as frail (CFS ≥ 5), pre-frail (CFS 3-4) and non-frail (CFS 1-2). Kaplan-Meier curves and a multivariate Cox model were used to examine the association between frailty and mortality. At the 6 month follow-up, we assessed psychological, physical, cognitive outcomes, and health-related quality of life (QoL) using descriptive statistics and linear regressions.

Results: We enrolled 531 patients, of which 178 (33.6%) were frail, 200 (37.6%) pre-frail and 153 (28.8%) non-frail. Frail patients were older, had more comorbidities, and greater disease severity at ICU admission. At 6 months, frail patients presented higher mortality rates than pre-frail and non-frail patients (34.3% (61/178) vs. 21% (42/200) vs. 13.1% (20/153) respectively, p < 0.01). The rate of withdrawing or withholding of care did not differ significantly between the groups. Compared with CFS 1-2, the adjusted hazard ratios of death at 6 months were 1.7 (95% CI 0.9-2.9) for CFS 3-4 and 2.9 (95% CI 1.7-4.9) for CFS ≥ 5. At 6 months, 192 patients were seen at a follow-up consultation. In multivariate linear regressions, CFS ≥ 5 was associated with poorer physical health-related QoL, but not with poorer mental health-related QoL, compared with CFS 1-2.

Conclusion: Frailty is associated with increased mortality and poorer physical health-related QoL in long-stay ICU patients at 6 months. The admission CFS can help inform patients and families about the complexities of survivorship during a prolonged ICU stay.

Keywords: Frailty; Goals of care; Long-stay ICU patients; Outcomes after critical illness.

Fig. 1

Survival Estimates According to Frailty, Using Kaplan–Meier

Fig. 2

Association of Frailty with Psychological, Cognitive, and Physical Outcomes at 6 Months after ICU Admission in Surviving ICU Patients. Regression coefficient plot with confidence intervals of standard multiple linear regressions. Definition of abbreviations: IES-R: Impact of Event Scale-Revised; HADS: Hospital Anxiety and Depression Scale, HADS-D: refers to the depression components of HADS, HADS-A: refers to the anxiety component of HADS; PCSF-12: physical component of the SF-12; MCSF-12: mental component of the SF-12; MMSE, Mini Mental State Examination. *Adjusted to: sex, ICU length of stay, reason for ICU admission, psychiatric comorbidities, presence of delirium. **Adjusted to: sex, ICU length of stay, reason for ICU admission