Mortality in Critically Ill Patients Increases Linearly with Frailty Status: A Population-Based Study
CCCF ePoster library. Hendin A. Nov 7, 2018; 233421
Dr. Ariel Hendin
Dr. Ariel Hendin
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Abstract
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Introduction:

Frailty is a syndrome of increased physiologic vulnerability to stressors, owing to an accumulation of deficits across multiple domains1,2. It is increasingly being recognized as a risk factor for accelerated functional decline, increasing dependency, and mortality in both inpatient and outpatient studies1,3–6. Although frailty is more common in older patients, it does not represent normal aging, and has also been identified in younger patients as a poor prognostic marker7,8. The Intensive Care (ICU) literature has also begun to point to frailty among critically ill patients as a predictor of mortality and poor outcomes9–12.

 

Objective:

We aimed to assess the outcomes, including mortality and health care associated costs, of patients admitted to the ICU who were frail compared to those who were pre-frail or robust. 

 

Methods:

This was a retrospective cohort study using data held at the Institute for Clinical Evaluative Sciences (ICES). We studied all patients age 18 and above who were admitted to an ICU in Ontario between April 2010 and March 2016 and who had a Resident Assessment Instrument for Home Care (RAI-HC) completed within 3 years prior to admission. Patients were stratified, based on a previously validated frailty index from the RAI-HC that assess cumulative deficits, as frail, pre-frail, or robust13,14. The primary study outcome was mortality at 1 year based on frailty status. Secondary outcomes included costs of admission and care at 1 year, ICU interventions, and hospital readmissions. 

 

Results:

Data from a RAI-HC assessment were available for 55 528 patients who were admitted to ICU in Ontario over the study period. Of those studied, 30.1% of patients were classified as robust, 37.2% as pre-frail, and 31.8% as frail. Overall mean age was 73.5 years and 53.8% of patients were female. Mortality rates increased significantly with frailty status, as demonstrated in Figure 1. By 1 year after ICU admission, 58.9% of the frail cohort had died, compared with 45.4% of the robust group (p < 0.001). Frail patients who survived were more likely to be admitted to long-term care within 1 year (18.6% vs 7.5%, p < 0.001). Total costs within 1 year were slightly higher in the frail cohort (median $28 444, compared with median $26 425, p < 0.001). 

 

Conclusion:

In this large, population-based study, frailty prior to ICU admission was associated with higher rates of institutionalization and very high mortality rates of nearly 60% in the year following critical illness. This is the first study to also examine cost outcomes in frail, critically ill patients. While costs were slightly higher in the frail cohort, they may have been offset by an increased mortality rate in this group.


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