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Is frailty a prognostic factor for critically ill elderly patients?

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Abstract

Aim

The study aimed to investigate the effects of frailty on clinical outcomes of patients in an intensive care unit (ICU).

Methods

In this prospective study, 122 patients (59 frail, 37 pre-frail and 26 robust) were included. A frailty index (FI) derived from comprehensive geriatric assessment parameters was used for the evaluation. The FI score of ≤0.25 was considered as robust, 0.25–0.40 as pre-frail and >0.40 as frail. The prognostic effects of FI were investigated and FI and APACHE II and SOFA scores, the prognostic scores using in ICU, were compared.

Results

Median age of the patients was 71 years old and 50.8 % were male. ICU mortality rate and median length of stay (LOS) were 51.6 % and 8 days (min–max: 1–148), respectively. ICU mortality was higher (69.2, 56.8 and 40.7 %, respectively, p = 0.040) and median overall survival was lower in frail group compared to pre-frail and robust subjects (23, 31 and 140 days, p = 0.013, respectively). Long term mortality over 3 and 6 months in frail patients were 80.8 and 84.6 %, respectively and significantly higher than others. Multivariate analysis showed that LOS in ICU (HR 1.067, 95 % CI 1.021–1.114), SOFA score (HR 1.272, 95 % CI 1.096–1.476) and FI (HR 39.019, 95 % CI 1.235–1232.537) were the independent correlates for ICU mortality (p = 0.004, p = 0.002 and 0.038, respectively). There was a weak but statistically significant positive correlation between APACHE II and FI scores (r = 0.190, p = 0.036).

Conclusions

FI may be used as a predictor for the evaluation of elderly patients’ clinical outcomes in ICUs.

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Author information

Authors and Affiliations

  1. Department of Internal Medicine, Division of Geriatrics, Gazi University School of Medicine, 06560, Besevler, Ankara, Turkey

    Muhammet Cemal Kizilarslanoglu, Ramazan Civelek, Mustafa Kemal Kilic, Fatih Sumer, Hacer Dogan Varan, Ozgur Kara, Gunes Arik & Zekeriya Ulger

  2. Department of Internal Medicine, Division of Intensive Care, Gazi University School of Medicine, Ankara, Turkey

    Melda Turkoglu & Gulbin Aygencel

Authors
  1. Muhammet Cemal Kizilarslanoglu
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  2. Ramazan Civelek
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  3. Mustafa Kemal Kilic
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  4. Fatih Sumer
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  5. Hacer Dogan Varan
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  6. Ozgur Kara
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  7. Gunes Arik
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  8. Melda Turkoglu
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  9. Gulbin Aygencel
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  10. Zekeriya Ulger
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Corresponding author

Correspondence to Muhammet Cemal Kizilarslanoglu.

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Conflict of interest

None.

Statement of human and animal rights

We complied of the ethical standards for human rights. The study protocol was approved by Clinical Investigation and Ethic Committee of Gazi University School of Medicine.

Informed consent

The patients were included in the study after taken informed consent from the patients or patient’s relatives if not possible to take it from the patients.

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Appendix

Appendix

Deficits counted

Points (max denominator 55)

Motivation

Low = 1

Self-rated health

Excellent = 0, good = 0.25, fair = 0.5, poor/can not say = 1

Cognition

Dementia = 1, Mild cog. Imp. = 0.5,

Delirium = 1

Agitation = 1

Delusions/hallucinations = 1

MMSE

24 or less = 1, >24 = 0

Emotional state

Anxiety = 1

Recent bereavement = 1

Depression = 1

Fatigue = 1

Sleep

Poor or disrupted = 1

 

Daytime drowsiness = 1

Speech

Impaired = 1

Hearing

Impaired = 1

Vision (with glasses)

Impaired = 1

Hemiparesis

Weak arm = 1

Weak leg = 1

Grip strength (on non-hemiplegic side)

Weak = 1

Proximal muscle strength (on non-hemiplegic side)

Weak = 1

Weight

Underweight = 1, Obese = 1, slightly overweight = 0

Weight change

Loss = 1, significant gain = 1

Appetite

Poor = 1, fair = 0.5, normal = 0

Continence

Bowels incontinent = 1

Bladder incontinent/catheter = 1

Medical History (scoring 1 point each)

Hypertension

Asthma/Chronic obstructive lung disease

Stroke/Transient ischaemic attack

Angina/Myocardial infarction

Heart Failure

Diabetes

Active cancer

Alcohol excess

Pressure sores

Hip fracture

Osteoarthritis/osteoporosis

Parkinson’s disease

1st other medical problem

2nd other medical problem

No. of medications in 24 h

0–4 = 0, 5–9 = 1, 10–14 = 2, 15–19 = 3, 20–24 = 4, >25 = 5

Transfers

Dependent = 1, assistance = 0.5

Walking

Dependent = 1, assistance = 0.5

Movements slow

Yes = 1

Sitting balance

Impaired = 1

Falls in the last 6 months

3 or more = 1

Feeding

Dependent = 1, assistance = 0.5

Washing

Dependent = 1, assistance = 0.5

Dressing

Dependent = 1, assistance = 0.5

Could manage own medications

Dependent = 1, assistance = 0.5

Could manage own finances

Dependent = 1, assistance = 0.5

  1. This Frailty index (Appendix) is taken from the study written by Krishnan et al. and modified [10]. MMSE: Mini-mental state examination. Underweight refers to body mass index <18.5 kg/m2 and overweight refers to body mass index between 25.0 and 29.9 kg/m2

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Kizilarslanoglu, M.C., Civelek, R., Kilic, M.K. et al. Is frailty a prognostic factor for critically ill elderly patients?. Aging Clin Exp Res 29, 247–255 (2017). https://doi.org/10.1007/s40520-016-0557-y

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