Admission Frailty Laboratory Index (FI-LAB) and Associated Mortality and Costs in Older ICU Patients with Suspected Infection
CCCF ePoster library. Fernando S. Nov 7, 2018; 233429; 39
Dr. Shannon Fernando
Dr. Shannon Fernando
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Abstract
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Introduction: Risk-stratification of patients with suspected infection is important. Existing prognostic tools (such as SIRS and qSOFA criteria) lack accuracy in older patients with suspected infection. Therefore, new methods for accurate outcome prognostication in older people with suspected infection are needed. Frailty, a syndrome based on accumulation of age- and disease-related deficits, is associated with vulnerability to adverse health outcomes. However, the association of frailty with adverse outcomes among older patients with suspected infection is poorly described.

 

Objectives: We sought to determine the prognostic accuracy of the frailty laboratory index (FI-LAB) for prediction of in-hospital mortality among older patients (i.e. ≥65 years of age) with suspected infection.

 

Methods: We utilized prospectively collected ICU registry data gathered from 2012-2016 at two hospitals in Ottawa, ON. We included consecutive patients ≥65 years of age, with suspected infection (defined by the concomitant administration of oral or parenteral antibiotics, and sampling of body fluid cultures). FI-LAB was calculated using laboratory values at the time of hospital admission. To reduce the confounding influence of illness severity, we excluded patients who died within 48 hours of hospital admission, and those who presented with septic shock (as per Sepsis-3 criteria). Patients were categorized as “Low FI-LAB” (FI-LAB <0.23), “Moderate FI-LAB” (FI-LAB 0.23-0.43), and “High FI-LAB” (FI-LAB >0.43). The primary outcome was in-hospital mortality, which we analyzed using a multivariable logistic regression model. We also evaluated total hospital costs.

 

Results: Of 1,510 included patients, 533 (35.3%) had a Low FI-LAB, 829 (54.9%) had a Moderate FI-LAB, and 148 (9.8%) had a High FI-LAB. There was only mild correlation between FI-LAB score and illness severity, as measured by the Multiple Organ Dysfunction Score (MODS, ρ = 0.274). Mean age was 76.3 years (SD: 7.9). In-hospital mortality in the cohort was 37.0%, 9.2% among Low FI-LAB patients, 45.5% among Moderate FI-LAB patients, and 89.2% among High FI-LAB patients. As compared to Low FI-LAB patients, adjusted odds of mortality among Moderate FI-LAB patients was 5.72 (95% CI: 4.06-8.05, P < 0.001) and High FI-LAB patients was 17.15 (95% CI: 9.10-21.56, P < 0.001). Adjusted ORs for patient age and MODS were 1.01 (95% CI: 0.99-1.04, P = 0.09) and 1.16 (95% CI:1.11-1.22, P < 0.01), respectively. Mean costs were significantly higher for Moderate FI-LAB patients ($47,116, SD: 41,321) than Low FI-LAB patients ($42,526, SD: 37,266), and High FI-LAB patients ($37,128, SD: 38,225) (P < 0.001).      

 

Conclusions: The FI-LAB score is prognostic of in-hospital mortality among older ICU patients with suspected infection, independent of age and severity of illness. Clinicians should consider frailty (and namely, the FI-LAB) as an important prognostic factor in discussions related to treatment course and goals-of-care in this population.


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