Title |
Association of frailty with short-term outcomes, organ support and resource use in critically ill patients
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Published in |
Intensive Care Medicine, August 2018
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DOI | 10.1007/s00134-018-5342-2 |
Pubmed ID | |
Authors |
Fernando G. Zampieri, Theodore J. Iwashyna, Elizabeth M. Viglianti, Leandro U. Taniguchi, William N. Viana, Roberto Costa, Thiago D. Corrêa, Carlos Eduardo N. Moreira, Marcelo O. Maia, Giulliana M. Moralez, Thiago Lisboa, Marcus A. Ferez, Carlos Eduardo F. Freitas, Clayton B. de Carvalho, Bruno F. Mazza, Mariza F. A. Lima, Grazielle V. Ramos, Aline R. Silva, Fernando A. Bozza, Jorge. I. F. Salluh, Marcio Soares, for the ORCHESTRA Study Investigators |
Abstract |
Frail patients are known to experience poor outcomes. Nevertheless, we know less about how frailty manifests itself in patients' physiology during critical illness and how it affects resource use in intensive care units (ICU). We aimed to assess the association of frailty with short-term outcomes and organ support used by critically ill patients. Retrospective analysis of prospective collected data from 93 ICUs in Brazil from 2014 to 2015. We assessed frailty using the modified frailty index (MFI). The primary outcome was in-hospital mortality. Secondary outcomes were discharge home without need for nursing care, ICU and hospital length of stay (LOS), and utilization of ICU organ support and transfusion. We used mixed logistic regression and competing risk models accounting for relevant confounders in outcome analyses. The analysis consisted of 129,680 eligible patients. There were 40,779 (31.4%) non-frail (MFI = 0), 64,407 (49.7%) pre-frail (MFI = 1-2) and 24,494 (18.9%) frail (MFI ≥ 3) patients. After adjusted analysis, frailty was associated with higher in-hospital mortality (OR 2.42, 95% CI 1.89-3.08), particularly in patients admitted with lower SOFA scores. Frail patients were less likely to be discharged home (OR 0.36, 95% CI 0.54-0.79) and had higher hospital and ICU LOS than non-frail patients. Use of all forms of organ support (mechanical ventilation, non-invasive ventilation, vasopressors, dialysis and transfusions) were more common in frail patients and increased as MFI increased. Frailty, as assessed by MFI, was associated with several patient-centered endpoints including not only survival, but also ICU LOS and organ support. |
X Demographics
Geographical breakdown
Country | Count | As % |
---|---|---|
United States | 18 | 15% |
United Kingdom | 16 | 14% |
Australia | 7 | 6% |
Canada | 5 | 4% |
Spain | 5 | 4% |
France | 5 | 4% |
Colombia | 4 | 3% |
Chile | 2 | 2% |
Japan | 2 | 2% |
Other | 17 | 14% |
Unknown | 37 | 31% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Members of the public | 63 | 53% |
Practitioners (doctors, other healthcare professionals) | 28 | 24% |
Scientists | 22 | 19% |
Science communicators (journalists, bloggers, editors) | 5 | 4% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 117 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Researcher | 18 | 15% |
Student > Ph. D. Student | 15 | 13% |
Student > Master | 10 | 9% |
Student > Doctoral Student | 8 | 7% |
Student > Bachelor | 8 | 7% |
Other | 24 | 21% |
Unknown | 34 | 29% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 45 | 38% |
Nursing and Health Professions | 17 | 15% |
Agricultural and Biological Sciences | 5 | 4% |
Social Sciences | 4 | 3% |
Computer Science | 2 | 2% |
Other | 8 | 7% |
Unknown | 36 | 31% |