Shannon M Fernando1,2, Daniel I McIsaac3,4,5, Jeffrey J Perry2,4,5, Bram Rochwerg6,7, Sean M Bagshaw8, Kednapa Thavorn4,5, Andrew J E Seely1,4,5,9, Alan J Forster4,5,10, Kirsten M Fiest11, Chintan Dave10, Alexandre Tran4,9, Peter M Reardon1,2, Peter Tanuseputro4,5,12,13, Kwadwo Kyeremanteng1,5,13. 1. Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. 2. Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada. 3. Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada. 4. School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada. 5. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. 6. Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada. 7. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. 8. Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada. 9. Department of Surgery, University of Ottawa, Ottawa, ON, Canada. 10. Department of Medicine, University of Ottawa, Ottawa, ON, Canada. 11. Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada. 12. Bruyere Research Institute, Ottawa, ON, Canada. 13. Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Abstract
OBJECTIVES: Suspected infection and sepsis are common conditions seen among older ICU patients. Frailty has prognostic importance among critically ill patients, but its impact on outcomes and resource utilization in older patients with suspected infection is unknown. We sought to evaluate the association between patient frailty (defined as a Clinical Frailty Scale ≥ 5) and outcomes of critically ill patients with suspected infection. We also evaluated the association between frailty and the quick Sequential Organ Failure Assessment score. DESIGN: Analysis of a prospectively collected registry. SETTING: Two hospitals within a single tertiary care level hospital system between 2011 and 2016. PATIENTS: We analyzed 1,510 patients 65 years old or older (at the time of ICU admission) and with suspected infection at the time of ICU admission. Of these, 507 (33.6%) were categorized as "frail" (Clinical Frailty Scale ≥ 5). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcome was in-hospital mortality. A total of 558 patients (37.0%) died in-hospital. Frailty was associated with increased risk of in-hospital death (adjusted odds ratio, 1.81 [95% CIs, 1.34-2.49]). Frailty was also associated with higher likelihood of discharge to long-term care (adjusted odds ratio, 2.06 [95% CI, 1.50-2.64]) and higher likelihood of readmission within 30 days (adjusted odds ratio, 1.83 [95% CI, 1.38-2.34]). Frail patients had increased ICU resource utilization and total costs. The combination of frailty and quick Sequential Organ Failure Assessment greater than or equal to 2 further increased the risk of death (adjusted odds ratio, 7.54 [95% CI, 5.82-9.90]). CONCLUSIONS: The presence of frailty among older ICU patients with suspected infection is associated with increased mortality, discharge to long-term care, hospital readmission, resource utilization, and costs. This work highlights the importance of clinical frailty in risk stratification of older ICU patients with suspected infection.
OBJECTIVES: Suspected infection and sepsis are common conditions seen among older ICU patients. Frailty has prognostic importance among critically illpatients, but its impact on outcomes and resource utilization in older patients with suspected infection is unknown. We sought to evaluate the association between patient frailty (defined as a Clinical Frailty Scale ≥ 5) and outcomes of critically illpatients with suspected infection. We also evaluated the association between frailty and the quick Sequential Organ Failure Assessment score. DESIGN: Analysis of a prospectively collected registry. SETTING: Two hospitals within a single tertiary care level hospital system between 2011 and 2016. PATIENTS: We analyzed 1,510 patients 65 years old or older (at the time of ICU admission) and with suspected infection at the time of ICU admission. Of these, 507 (33.6%) were categorized as "frail" (Clinical Frailty Scale ≥ 5). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcome was in-hospital mortality. A total of 558 patients (37.0%) died in-hospital. Frailty was associated with increased risk of in-hospital death (adjusted odds ratio, 1.81 [95% CIs, 1.34-2.49]). Frailty was also associated with higher likelihood of discharge to long-term care (adjusted odds ratio, 2.06 [95% CI, 1.50-2.64]) and higher likelihood of readmission within 30 days (adjusted odds ratio, 1.83 [95% CI, 1.38-2.34]). Frail patients had increased ICU resource utilization and total costs. The combination of frailty and quick Sequential Organ Failure Assessment greater than or equal to 2 further increased the risk of death (adjusted odds ratio, 7.54 [95% CI, 5.82-9.90]). CONCLUSIONS: The presence of frailty among older ICU patients with suspected infection is associated with increased mortality, discharge to long-term care, hospital readmission, resource utilization, and costs. This work highlights the importance of clinical frailty in risk stratification of older ICU patients with suspected infection.
Authors: N Tarquinio; G Viticchi; V Zaccone; M Martino; A Fioranelli; P Morciano; G Moroncini; C Di Pentima; A Martini; C Nitti; A Salvi; M Burattini; L Falsetti Journal: Intern Emerg Med Date: 2021-01-11 Impact factor: 3.397
Authors: Christian Labenz; Wolfgang M Kremer; Jörn M Schattenberg; Marcus-Alexander Wörns; Gerrit Toenges; Arndt Weinmann; Peter R Galle; Martin F Sprinzl Journal: J Investig Med Date: 2020-07-07 Impact factor: 2.895
Authors: Shannon M Fernando; Rebecca Mathew; Benjamin Hibbert; Bram Rochwerg; Laveena Munshi; Allan J Walkey; Morten Hylander Møller; Trevor Simard; Pietro Di Santo; F Daniel Ramirez; Peter Tanuseputro; Kwadwo Kyeremanteng Journal: Crit Care Date: 2020-01-13 Impact factor: 9.097
Authors: Wolfgang M Kremer; Michael Nagel; Michael Reuter; Max Hilscher; Maurice Michel; Leonard Kaps; Joachim Labenz; Peter R Galle; Martin F Sprinzl; Marcus-Alexander Wörns; Christian Labenz Journal: Clin Transl Gastroenterol Date: 2020-07 Impact factor: 4.396