Bagshaw SM, Stelfox HT, McDermid RC, et al.
CMAJ 2014;186:E95-102
Publication date: February 4, 2014
Summary
Frailty has not been evaluated in critically ill patients. The development of critical illness may lead to frailty in vulnerable patients, and critical illness may be a key factor impeding recovery and functional autonomy in those already considered to be frail.
The authors performed a prospective multicenter study in an unselected cohort of critically ill patients in order to determine the prevalence of frailty and its association with outcomes among adults admitted to intensive care.
A total of 421 critically ill adults aged 50 years or older were prospectively enrolled at 6 hospitals across the province of Alberta, Canada. Frailty was defined by a score greater than 4 on the Clinical Frailty Scale. The primary outcome measure was in-hospital mortality, and secondary outcome measures included adverse events, 1-year mortality and quality of life.
The prevalence of frailty was 32.8%. Frail patients were older, were more likely to be female, and had more comorbidities and greater functional dependence than those who were not frail. In-hospital mortality was higher among frail patients than among non-frail patients (32% vs. 16%; adjusted odds ratio 1.81; 95% CI 1.09-3.01) and remained higher at 1 year (48% vs. 25%; adjusted hazard ratio 1.82; 95% CI 1.28-2.60). Compared with non-frail survivors, frail survivors were more likely to become functionally dependent, had significantly lower quality of life and were more often readmitted to hospital in the 12 months following enrolment.
Frailty, the authors conclude, is common among critically ill adults aged 50 years or older and identifies a population at increased risk of adverse events, morbidity and mortality. Diagnosis of frailty could improve prognostication and identify a vulnerable population that might benefit from follow-up and intervention.