Jai N Darvall1, Kate Greentree2, Ms Sabine Braat3, David A Story4, Wen K Lim5. 1. Departments of Intensive Care and Anaesthesia/Pain Management, Royal Melbourne Hospital, Melbourne, Australia; Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Australia. Electronic address: jai.darvall@mh.org.au. 2. Departments of Intensive Care and Anaesthesia/Pain Management, Royal Melbourne Hospital, Melbourne, Australia. 3. Centre for Epidemiology and Biostatistics, Melbourne Clinical and Translational Science Platform, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia. 4. Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Australia. 5. Department of Medicine, University of Melbourne, Melbourne, Australia.
Abstract
PURPOSE: Frailty in critical illness is common and associated with poor outcomes, however little is known about contributing factors. We compared the Clinical Frailty Scale (CFS) with a multi-dimensional validated tool, the Edmonton Frail Scale (EFS), and investigated which health domains are affected by frailty in ICU. MATERIALS AND METHODS: This prospective cohort study enrolled patients aged ≥50 years admitted between February-June 2017, comparing the CFS and EFS using Spearman correlation and Kappa coefficients, assessing frailty status across health domains, and examining outcomes including mortality. RESULTS: One hundred and sixty patients were enrolled, 33.8% were frail. Frail patients had greater in-hospital and 6-month mortality [25.9% vs. 8.5%; adjusted OR (95% CI) = 3.31 (1.17, 9.39), p = .024; and 40.4% vs. 17.3%; OR (95% CI) = 2.84 (1.18, 6.83), p = .020 respectively]. CFS and EFS scales were highly correlated [Spearman correlation coefficient = 0.85 (95% CI 0.81-0.88)], with high agreement [kappa coefficient = 0.78 (95% CI: 0.68-0.88)]. Frail patients had worse health status across the spectrum of frailty domains, in particular functional dependence, malnutrition, and prior hospital admissions. CONCLUSIONS: Frailty in the critically ill affects a range of health deficits, adequately measured via the CFS.
PURPOSE: Frailty in critical illness is common and associated with poor outcomes, however little is known about contributing factors. We compared the Clinical Frailty Scale (CFS) with a multi-dimensional validated tool, the Edmonton Frail Scale (EFS), and investigated which health domains are affected by frailty in ICU. MATERIALS AND METHODS: This prospective cohort study enrolled patients aged ≥50 years admitted between February-June 2017, comparing the CFS and EFS using Spearman correlation and Kappa coefficients, assessing frailty status across health domains, and examining outcomes including mortality. RESULTS: One hundred and sixty patients were enrolled, 33.8% were frail. Frail patients had greater in-hospital and 6-month mortality [25.9% vs. 8.5%; adjusted OR (95% CI) = 3.31 (1.17, 9.39), p = .024; and 40.4% vs. 17.3%; OR (95% CI) = 2.84 (1.18, 6.83), p = .020 respectively]. CFS and EFS scales were highly correlated [Spearman correlation coefficient = 0.85 (95% CI 0.81-0.88)], with high agreement [kappa coefficient = 0.78 (95% CI: 0.68-0.88)]. Frail patients had worse health status across the spectrum of frailty domains, in particular functional dependence, malnutrition, and prior hospital admissions. CONCLUSIONS: Frailty in the critically ill affects a range of health deficits, adequately measured via the CFS.