Frailty in Critically Ill Non-Elderly Patients: Prevalence, Correlates, and Outcomes
CCCF ePoster library. Bagshaw S. Oct 26, 2015; 117300; P18 Disclosure(s): This study was supported from grants from the Canadian Institutes of Health Research; Canadian Intensive Care Foundation, University Hospital Foundation.
Dr. Sean M Bagshaw
Dr. Sean M Bagshaw
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Abstract
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P18


Topic: Retrospective or Prospective Cohort Study


Frailty in Critically Ill Non-Elderly Patients: Prevalence, Correlates, and Outcomes



Sean Bagshaw, S. Majumdar, D. Rolfson, Q. Ibrahim, R. McDermid, H. Stelfox

Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada | Medicine, University of Alberta, Edmonton, Canada | Medicine, University of Alberta, Edmonton, Canada | EPICORE Centre, University of Alberta, Edmonton, Canada | Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada | Critical Care Medicine, Faculty of Medicine, University of Calgary, Edmonton, Canada

Introduction: Frailty is a multi-dimensional syndrome characterized by loss of physiologic and cognitive reserve that heightens vulnerability to unfavorable outcomes. Frailty is conventionally described in elderly patients, typically defined as 65 years of age or more; however; no studies have evaluated the role of frailty in critically ill non-elderly patients.

Objectives: To describe the prevalence, correlates, and outcomes associated with frailty among critically ill patients aged <65 years.

Methods: Prospective cohort study of 197 consecutive critically ill patients aged 50-65 years admitted to intensive care units (ICU) in six hospitals across Alberta, Canada. Frailty was operationalized as a score of >4 on the Clinical Frailty Scale (CFS) prior to index hospitalization. Multivariable analyses, adjusted for socio-demographics, case-mix and severity of presenting illness, were used to evaluate the independent variables associated with frailty prior to ICU admission and the independent association between frailty on long-term survival.

Results: Frailty was present in 28% (n=55; 95% CI, 21.8-34.7) of the non-elderly. Factors independently associated with frailty included not completely independent in the community (adjusted odds ratio [aOR] 4.4; 95% CI, 1.8-11.1; independent model contribution 49%) connective tissue disease (aOR 6.0; 95% CI, 2.1-17.0; independent model contribution 20%) and hospitalization within the preceding year (aOR 3.3; 95% CI, 1.3-8.1; independent model contribution 12%). There were no clinically important or statistically significant differences in reasons for admission, admission APACHE II score, preferences for life support, or treatment intensity (e.g., mechanical ventilation, vasoactive support or renal replacement therapy) between non-elderly frail and not frail patients. Non-elderly frail patients had similar (median [IQR]) lengths of hospital stay (26 [9-68] vs. 19 [10-43] days p=0.4) but had greater 1-year rehospitalisation rates (61% vs. 40%, p=0.02) and higher 1-year mortality (33% vs 20%, adjusted hazard ratio 1.8; 95% CI, 1.0-3.3, p=0.05). Frailty ranked as the third most important independent model contributor to 1-year mortality after burden of comorbidity and severity of presenting illness.

Conclusion: Premorbid frailty is common among non-elderly critically ill patients, particularly those who were not completely independent or who had connective tissue diseases and recent hospitalizations and it was independently associated with higher rates of rehospitalization and mortality at 1-year. Our data suggests that frailty needs to be recognized and accounted for in managing middle-aged and older adults admitted to ICU, and not just the elderly.


References:
  1. Bagshaw SM, Stelfox HT, McDermid RC, Rolfson D, Tsuyuki RT, Baig N, Artiuch B, Ibrahim Q, Stollery DE, Rokosh E, Majumdar SR. Association Between Frailty and Short and Long-Term Outcomes In Critically Ill Patients: A Multi-Centre Prospective Cohort Study. CMAJ 2014;186(2):E95-102.
  2. Bagshaw SM, Stelfox HT, Johnson JA, McDermid RC, Rolfson DB, Tsuyuki RT, Ibrahim Q, Majumdar SR. Long-term association between frailty and health-related quality-of-life among survivors of critical illness: A prospective multi-centre cohort study. Crit Care Med 2015; 43(5): 973-82.
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