6533b829fe1ef96bd128a5bb
RESEARCH PRODUCT
The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (≥ 80 years)
Hans FlaattenDylan W. De LangeAlessandro MorandiFinn H. AndersenAntonio ArtigasGuido BertoliniAriane BoumendilMaurizio CecconiSteffen ChristensenLoredana FaraldiJesper FjølnerChristian JungBrian MarshRui MorenoSandra OeyenChristina Agwald ÖHmanBernardo Bollen PintoIvo W. SolimanWojciech SzczeklikAndreas ValentinXimena WatsonTilemachos ZaferidisBertrand GuidetRené SchmutzFranz WimmerPhilipp EllerKlemens ZotterWalter SwinnenPieter De BuysscherNikolaas De NevePaul AbrahamYvan FleuryJoerg C. SchefoldEwelina BiskupIoannis TaliadorosPetr PizaAlexander LautenAnna Lena SacherThorsten BrennerMarcus FranzFrank BloosHenning EbeltStefan J. SchallerKristina FuestChristian RabeThorben DieckStephan SteinerTobias GrafAmir M. NiaRolf Alexander JanosiPatrick MeybohmPhilipp SimonStefan UtzolinoTim RahmelEberhard BarthMichael SchusterNilanjan DeyChristoffer SøllingBodil Steen RasmussenEnver RodriguezSergio RebolloGerardo AguilarGaspar MasdeuMarián Irazábal JaimesÁNgela Prado MiraMaria A. BodiJesus A. Barea MendozaSonia López-cuencaMarcela Homez GuzmanJesús Rico-feijooMercedes IbarzJosep Trenado-alvarezXavier ForcevilleGuillaume BeschHerve MentecPhilippe MichelPhilippe MateuLucie VettorettiJeremy BourenneNathalie MarinMax GuillotNaida AissaouiCyril GoulenokNathalie Thieulot-rolinJonathan MessikaLionel LamhautCyril CharronGed DempseyShiju J. MathewAshok S. RajIrina GrecuJason CupittTom LawtonRichard ClarkMonica PopescuNick SpittleMaria FaulknerAmanda CowtonEsme EllowayPatricia WilliamsMichael ReaySrikanth ChukkambotlaRavi KumarNawaf Al-subaieLinda KentTiina TammIstvan KajtorKaren BurnsRichard PughMarlies OstermannElisa KamHelen BowyerNeil SmithMaie TempletonJeremy HenningKelly GoffinRitoo KapoorShondipon LahaPhil ChiltonWaqas KhaliqAlison CrayfordSamantha CoetzeeMoira TaitEvangelos BoultoukasWendy StokerMarc GimenezAlan PopeJulie CamsooksaiDavid PogsonKate QuigleyJenny RitzemaAnil HormisCarole BoulangerM. BalasubramaniamLuke VamplewKaren BurtDaniel MartinJayne CraigJohn ProwleNanci DoyleJonathon SheltonCarmen ScottPhil DonnisonSarah SheltonChristian FreyChristine RyanDominic SprayVeronica BarnesKerry BarnesJulie FurnevalStephanie RidgwayRajnish SahaThomas ClarkJames WoodClare BolgerChristopher BassfordJohn LewandowskiXiaobei ZhaoSally HumphreysSusan DowlingNeil RichardsonAndrew BurtenshawCarl StevensonDanielle WilcockZoi AidoniStavros AloizosPolychronis TasioudisKleri LampiriVasiliki ZisopoulouRavani IfigeniaPagaki EymorfiaAnttoniou AngelaTheodoros A. KatsoulasAikaterini KyparissiKounougeri AikateriniGeorge MarinakisFotios TsimpoukasAnastasia SpyropoulouParis ZygoulisIvan HayesYvelynne KellyAndrew WestbrookGerry FitzpatrickDarshana MaheshwariCatherine MotherwayManish GuptaMohan GurjarIsmail M MajiGiovanni NegriSavino SpadaroGiuseppe NattinoMatteo PedeferriAnnalisa BoscoloSimona RossiMaurizio RossiGiuseppe CalicchioLucia CubattoliGabriella Di LascioMaria BarbagalloFrancesco BerrutoDaniela CodazziAndrea BottazziPaolo FumagalliGiancarlo NegroGiuseppe LupiFlavia SavelliGiuseppe A. VulcanoRoberto FumagalliAndrea MarudiUgo LefonsRita LemboMaria BabiniAlessandra PaggioroVieri ParriniMaria ZaccariaStefano ClementiCarmelo GigliutoFrancesca FacondiniSimonetta PastoriniSusanna MunaronItalo CalamaiAnna BocchiElisabetta BrizioAdele AdorniMaria Grazia BocciAndrea CortegianiTiziana CasalicchioSerena MelleaElia GrazianiMassimo BarattiniI. Van DijkL. E. M. Van Lelyveld-haasD. RamnarainTim JansenFleur NooteboomPeter H. J. Van Der VoortWillem DieperinkMonique C. De WaardLaura BormansMichael HahnNicolai KemmererHans Frank StrietzelLutz FehrleKnut DybwikTerje LegernaesPål KlepstadEven Braut OlaussenKnut Inge OlsenOle Marius BørresenGeir BjørsvikSameer MainiMiroslaw CzuczwarPawel KrawczykMirosław ZiętkiewiczŁUkasz R. NowakKatarzyna KotfisKatarzyna CwylRyszard GajdoszJowita BiernawskaPaweł GrudzieńPaweł NasiłowskiNatalia PopekWaldemar CyrankiewiczMarek WnukDariusz MaciejewskiDorota StudzińskaMaciej ZukowskiSzymon BernasMarta SerwaJan StefaniakMaciejewski PawelMalgorzata SzymkowiakBarbara AdamikNuno CatorzeMiguel Castelo BrancoInês BarrosNelson BarrosAndriy KrystopchukTeresa HonradoCristina SousaFrancisco MunozMarta RebeloRui GomesJorge NunesCeleste DiasAna Margarida FernandesCristina PetrisorBodolea ConstantinVladislav BelskiyBoris BoskholovRafael KawatiJoakim SivikJessica NauskaDaniel SmoleFredric ParenmarkJohanna LyrénKatalin RockstrohSara RydénMartin SpångforsMorten StrinnholmSten WaltherLina De GeerPeter NordlundStaffan PålssonHarald ZetterquistAnnika NilssonKarin ThiringerMårten JungnerBjörn BarkBerit NordlingHans SköldCamilla BrorssonStefan PerssonAnna BergströmJohan BerkiusJohanna HolmströmNihan Yapicisubject
MaleTime FactorsOutcome AssessmentFrail Elderly/statistics & numerical data[SDV]Life Sciences [q-bio]HSJ UCIPassiveCritical Care and Intensive Care MedicineFrailty/classification/diagnosis/mortality/therapySeverity of Illness IndexSeverity of illneElderly0302 clinical medicineQuality of lifeElderly; Frailty; ICU; Mortality; Octogenarians; Severity of illness; Aged 80 and over; Critical Illness; Europe; Euthanasia Passive; Female; Frail Elderly; Frailty; Geriatric Assessment; Humans; Intensive Care Units; Length of Stay; Male; Outcome Assessment Health Care; Proportional Hazards Models; Prospective Studies; Quality of Life; Severity of Illness Index; Time Factors; Hospital MortalityOutcome Assessment Health Care80 and overProspective StudiesHospital Mortality030212 general & internal medicineProspective cohort studyAged 80 and overeducation.field_of_studyddc:617FrailtyMortality rate[SDV] Life Sciences [q-bio]EuropeIntensive Care UnitsLength of Stay/statistics & numerical dataCohortIntensive Care Units/statistics & numerical dataCritical IllneFemaleSOFA scoreHumanmedicine.medical_specialtyOctogenariansTime FactorCritical IllnessFrail ElderlyIntensive Care UnitPopulationINTENSIVE-CARESeverity of illnessEurope/epidemiologyOutcome Assessment (Health Care)03 medical and health sciencesOctogenarianIntensive careSeverity of illnessJournal ArticlemedicineHumansCOHORTMortalityOctogenarinansIntensive care medicineeducationGeriatric AssessmentAgedProportional Hazards ModelsOLDEREuthanasiabusiness.industry030208 emergency & critical care medicineLength of StayEuthanasia PassiveHealth CareProspective StudieCritical Illness/mortalityUNITICUEmergency medicineProportional Hazards ModelQuality of Lifebusinessdescription
Purpose: Very old critical ill patients are a rapid expanding group in the ICU. Indications for admission, triage criteria and level of care are frequently discussed for such patients. However, most relevant outcome studies in this group frequently find an increased mortality and a reduced quality of life in survivors. The main objective was to study the impact of frailty compared with other variables with regards to short-term outcome in the very old ICU population. Methods: A transnational prospective cohort study from October 2016 to May 2017 with 30 days follow-up was set up by the European Society of Intensive Care Medicine. In total 311 ICUs from 21 European countries participated. The ICUs included the first consecutive 20 very old (≥ 80 years) patients admitted to the ICU within a 3-month inclusion period. Frailty, SOFA score and therapeutic procedures were registered, in addition to limitations of care. For measurement of frailty the Clinical Frailty Scale was used at ICU admission. The main outcomes were ICU and 30-day mortality and survival at 30 days. Results: A total of 5021 patients with a median age of 84 years (IQR 81–86 years) were included in the final analysis, 2404 (47.9%) were women. Admission was classified as acute in 4215 (83.9%) of the patients. Overall ICU and 30-day mortality rates were 22.1% and 32.6%. During ICU stay 23.8% of the patients did not receive specific ICU procedures: ventilation, vasoactive drugs or renal replacement therapy. Frailty (values ≥ 5) was found in 43.1% and was independently related to 30-day survival (HR 1.54; 95% CI 1.38–1.73) for frail versus non-frail. Conclusions: Among very old patients (≥ 80 years) admitted to the ICU, the consecutive classes in Clinical Frailty Scale were inversely associated with short-term survival. The scale had a very low number of missing data. These findings provide support to add frailty to the clinical assessment in this patient group. Trial registration: ClinicalTrials.gov (ID: NCT03134807).
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2017-12-01 | Intensive Care Medicine |