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Impact of frailty on persistent critical illness: a population-based cohort study

Darvall, Jai N. ; Bellomo, Rinaldo ; Bailey, Michael ; Young, Paul J. ; Rockwood, Kenneth ; Pilcher, David

Intensive care medicine, 2022-03, Vol.48 (3), p.343-351 [Periódico revisado por pares]

Berlin/Heidelberg: Springer Berlin Heidelberg

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Título:
Impact of frailty on persistent critical illness: a population-based cohort study
Autor: Darvall, Jai N. ; Bellomo, Rinaldo ; Bailey, Michael ; Young, Paul J. ; Rockwood, Kenneth ; Pilcher, David
Assuntos: Adult ; Analysis ; Anesthesiology ; Australia ; Cohort analysis ; Cohort Studies ; Critical Care Medicine ; Critical Illness ; Emergency Medicine ; Frailty ; Health aspects ; Hospital Mortality ; Hospital patients ; Humans ; Illnesses ; Intensive ; Intensive care ; Intensive Care Units ; Medical research ; Medicine ; Medicine & Public Health ; Medicine, Experimental ; Mortality ; New Zealand ; Observational studies ; Original ; Pain Medicine ; Patients ; Pediatrics ; Pneumology/Respiratory System ; Population studies ; Population-based studies ; Prognosis ; Prospective Studies ; Secondary analysis
É parte de: Intensive care medicine, 2022-03, Vol.48 (3), p.343-351
Notas: ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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Descrição: Purpose Acute illness severity predicts mortality in intensive care unit (ICU) patients, however, its predictive value decreases over time in ICU. Typically after 10 days, pre-ICU (antecedent) characteristics become more predictive of mortality, defining the onset of persistent critical illness (PerCI). How patient frailty affects development and death from PerCI is unknown. Methods We conducted a secondary analysis of data from a prospective binational cohort study including 269,785 critically ill adults from 168 ICUs in Australia and New Zealand, investigating whether frailty measured with the Clinical Frailty Scale (CFS) changes the timing of onset and risk of developing PerCI and of subsequent in-hospital mortality. We assessed associations between frailty (CFS ≥ 5) and mortality prediction using logistic regression and area under the receiver operating characteristics (AUROC) curves. Results 2190 of 50,814 (4.3%) patients with frailty (CFS ≥ 5) versus 6624 of 218,971 (3%) patients without frailty (CFS ≤ 4) developed PerCI ( P < 0.001). Among patients with PerCI, 669 of 2190 (30.5%) with frailty and 1194 of 6624 without frailty (18%) died in hospital ( P < 0.001). The time point defining PerCI onset did not vary with frailty degree; however, with increasing length of ICU stay, inclusion of frailty progressively improved mortality discrimination (0.1% AUROC improvement on ICU day one versus 3.6% on ICU day 17). Conclusion Compared to patients without frailty, those with frailty have a higher chance of developing and dying from PerCI. Moreover the importance of frailty as a predictor of mortality increases with ICU length of stay. Future work should explore incorporation of frailty in prognostic models, particularly for long-staying patients.
Editor: Berlin/Heidelberg: Springer Berlin Heidelberg
Idioma: Inglês

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Impact of frailty on persistent critical illness: a population-based cohort study

Darvall, Jai N. ; Bellomo, Rinaldo ; Bailey, Michael ; Young, Paul J. ; Rockwood, Kenneth ; Pilcher, David

Berlin/Heidelberg: Springer Berlin Heidelberg

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