Sex-Specific Prevalence, Correlates and Outcomes of Frailty in Critically Ill Patients
CCCF ePoster library. Hessey E. 11/13/19; 283358; EP125
Erin Hessey
Erin Hessey
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Abstract
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ePoster
Topic: Retrospective or Prospective Cohort Study or Case Series

Hessey, Erin1; Montgomery, Carmel1; Zuege, Danny2,3,6; Rolfson, Darryl4; Stelfox, Henry2,5,6; Bagshaw, Sean M1,6
 
1. Department of Critical Care Medicine, Faculty of Medicine and Dentistry and Alberta Health Services – Edmonton Zone, University of Alberta, Edmonton, Canada
2. Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services – Calgary Zone, Calgary, Canada
3. eCritical Alberta, Alberta Health Services, Calgary, Canada
4. Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
5. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
6. Alberta Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, Canada


INTRODUCTION: Frailty is increasingly being recognized as an important risk factor for worse short and long-term outcomes in hospitalized patients, and for greater health care service use.1-3 A recent study examining population-level screening of frailty in critically ill adults found differences in the prevalence of frailty by sex.4
 
OBJECTIVES: To determine if the prevalence of frailty in critically ill adults differs by sex, and if mortality and organ support rates differ in males living with frailty compared to females living with frailty. We hypothesized that the prevalence of frailty would differ by sex and that mortality and organ support rates would differ by sex stratified by frailty.
 
METHODS: This is a retrospective multi-centre population-based cohort study. All adult patients (aged ≥18 years) admitted to 17 intensive care units (ICUs) in Alberta between January 1, 2016 - June 30, 2017 were eligible. Patients missing a frailty score or who died within 24 hours of ICU admission were excluded. The primary source of data was eCritical Alberta, a bedside clinical information system and data repository. Frailty was defined as Clinical Frailty Scale (CFS) score ≥5.  The primary outcome was sex-stratified prevalence and severity of frailty. The secondary outcomes were ICU and hospital mortality, and receipt of organ support (i.e. invasive mechanical ventilation, vasoactive support, renal replacement therapy). The association between sex and frailty was evaluated using multivariable logistic regression. The association between sex, frailty and mortality was assessed using Chi2 tests and by multivariable Cox regression. The association between sex, frailty and organ support was assessed using Chi2 tests and by multivariable logistic regression.
 
RESULTS:
A total of 15,238 patients were included (mean age [standard deviation] 58 [17] years, 39% female). Twenty-eight percent (n=4,199) had a CFS score ≥5 at admission. Females had a higher prevalence of frailty compared to males (1,917/5,984 [32%] vs. 2,282/9,254 [25%], p<0.001) and in multivariable logistic regression were more likely to have a CFS score ≥5 (odds ratio 1.44 [1.33 – 1.56], p<0.001). APACHE II scores were similar (21.9 [8.1] for males vs. 21.9 [8.1] for females, p=0.61). Differences between females and males living with frailty are shown in Table 1. Differences in ICU and hospital mortality were not significant. Females received less invasive mechanical ventilation and vasoactive support compared to their male counterparts. In multivariable analysis females were significantly less likely to receive vasoactive support compared to males.
 
CONCLUSIONS:
Females admitted to the ICU have higher frailty scores and a larger proportion are frail (CFS score ≥5), compared to males. Females living with frailty received less intensive support compared to their male counterparts, despite similar illness acuity.


Image

REFERENCES:
1. Bagshaw SM, Stelfox HT, McDermid RC, et al. Association between frailty and short- and long-term outcomes among critically ill patients: a multicentre prospective cohort study. CMAJ. 2014;186(2): E95-102.
2. Brummel NE, Bell SP, Girard TD, et al. Frailty and Subsequent Disability and Mortality among Patients with Critical Illness. Am J Respir Crit Care Med. 2017;196(1):64-72.
3. Zampieri FG, Iwashyna TJ, Viglianti EM, et al. Association of frailty with short-term outcomes, organ support and resource use in critically ill patients. Intensive Care Med. 2018;44(9):1512-1520.
4. Montgomery CL, Zuege DJ, Rolfson DB, et al. Implementation of Population-Level Screening for Frailty Among Patients Admitted to Adult Intensive Care in Alberta, Canada. Can J Anaesth. 2019.

ePoster
Topic: Retrospective or Prospective Cohort Study or Case Series

Hessey, Erin1; Montgomery, Carmel1; Zuege, Danny2,3,6; Rolfson, Darryl4; Stelfox, Henry2,5,6; Bagshaw, Sean M1,6
 
1. Department of Critical Care Medicine, Faculty of Medicine and Dentistry and Alberta Health Services – Edmonton Zone, University of Alberta, Edmonton, Canada
2. Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services – Calgary Zone, Calgary, Canada
3. eCritical Alberta, Alberta Health Services, Calgary, Canada
4. Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
5. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
6. Alberta Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, Canada


INTRODUCTION: Frailty is increasingly being recognized as an important risk factor for worse short and long-term outcomes in hospitalized patients, and for greater health care service use.1-3 A recent study examining population-level screening of frailty in critically ill adults found differences in the prevalence of frailty by sex.4
 
OBJECTIVES: To determine if the prevalence of frailty in critically ill adults differs by sex, and if mortality and organ support rates differ in males living with frailty compared to females living with frailty. We hypothesized that the prevalence of frailty would differ by sex and that mortality and organ support rates would differ by sex stratified by frailty.
 
METHODS: This is a retrospective multi-centre population-based cohort study. All adult patients (aged ≥18 years) admitted to 17 intensive care units (ICUs) in Alberta between January 1, 2016 - June 30, 2017 were eligible. Patients missing a frailty score or who died within 24 hours of ICU admission were excluded. The primary source of data was eCritical Alberta, a bedside clinical information system and data repository. Frailty was defined as Clinical Frailty Scale (CFS) score ≥5.  The primary outcome was sex-stratified prevalence and severity of frailty. The secondary outcomes were ICU and hospital mortality, and receipt of organ support (i.e. invasive mechanical ventilation, vasoactive support, renal replacement therapy). The association between sex and frailty was evaluated using multivariable logistic regression. The association between sex, frailty and mortality was assessed using Chi2 tests and by multivariable Cox regression. The association between sex, frailty and organ support was assessed using Chi2 tests and by multivariable logistic regression.
 
RESULTS:
A total of 15,238 patients were included (mean age [standard deviation] 58 [17] years, 39% female). Twenty-eight percent (n=4,199) had a CFS score ≥5 at admission. Females had a higher prevalence of frailty compared to males (1,917/5,984 [32%] vs. 2,282/9,254 [25%], p<0.001) and in multivariable logistic regression were more likely to have a CFS score ≥5 (odds ratio 1.44 [1.33 – 1.56], p<0.001). APACHE II scores were similar (21.9 [8.1] for males vs. 21.9 [8.1] for females, p=0.61). Differences between females and males living with frailty are shown in Table 1. Differences in ICU and hospital mortality were not significant. Females received less invasive mechanical ventilation and vasoactive support compared to their male counterparts. In multivariable analysis females were significantly less likely to receive vasoactive support compared to males.
 
CONCLUSIONS:
Females admitted to the ICU have higher frailty scores and a larger proportion are frail (CFS score ≥5), compared to males. Females living with frailty received less intensive support compared to their male counterparts, despite similar illness acuity.


Image

REFERENCES:
1. Bagshaw SM, Stelfox HT, McDermid RC, et al. Association between frailty and short- and long-term outcomes among critically ill patients: a multicentre prospective cohort study. CMAJ. 2014;186(2): E95-102.
2. Brummel NE, Bell SP, Girard TD, et al. Frailty and Subsequent Disability and Mortality among Patients with Critical Illness. Am J Respir Crit Care Med. 2017;196(1):64-72.
3. Zampieri FG, Iwashyna TJ, Viglianti EM, et al. Association of frailty with short-term outcomes, organ support and resource use in critically ill patients. Intensive Care Med. 2018;44(9):1512-1520.
4. Montgomery CL, Zuege DJ, Rolfson DB, et al. Implementation of Population-Level Screening for Frailty Among Patients Admitted to Adult Intensive Care in Alberta, Canada. Can J Anaesth. 2019.

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