Nathan E Brummel1,2,3, Timothy D Girard3,4, Pratik P Pandharipande3,5, Jennifer L Thompson6, Ryan T Jarrett6, Rameela Raman3,6, Christopher G Hughes3,5, Mayur B Patel3,7,8,9, Alessandro Morandi3,10,11, Thomas M Gill12, E Wesley Ely3,13,14,15. 1. Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH. 2. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH. 3. Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN. 4. Clinical Research, Investigation, and Systems Modeling of Acute illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. 5. Division of Anesthesia Critical Care Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN. 6. Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN. 7. Division of Trauma, Surgical Critical Care, and Emergency General Surgery, Departments of Surgery, Neurosurgery, and Hearing and Speech Sciences, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN. 8. Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN. 9. Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN. 10. Geriatric Research Group, Brescia, Italy. 11. Department of Rehabilitation and Aged Care, Hospital Ancelle, Cremona, Italy. 12. Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT. 13. Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN. 14. Center for Health Services Research, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN. 15. Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN.
Abstract
OBJECTIVES: Little is known about frailty that develops following critical illness. We sought to describe the prevalence of newly acquired frailty, its clinical course, and the co-occurrence of frailty with disability and cognitive impairment in survivors of critical illness. DESIGN: Longitudinal prospective cohort study. SETTING: Medical and surgical ICUs at five U.S. centers. PATIENTS: Adult patients treated for respiratory failure and/or shock. MEASUREMENTS AND MAIN RESULTS: We measured frailty with the Clinical Frailty Scale at baseline (i.e., study enrollment) and at 3 and 12 months postdischarge. We constructed alluvial diagrams to describe the course of frailty and Venn diagrams to describe the overlap of frailty with disability in activities of daily living and cognitive impairment. We included 567 participants a median (interquartile range) of 61 years old (51-70 yr old) with a high severity of illness (Acute Physiology and Chronic Health Evaluation II of 23). Frailty (Clinical Frailty Scale scores ≥ 5) was present in 135 of 567 (24%) at baseline, 239 of 530 (45%) at 3 months, and 163 of 445 (37%) at 12 months. Of those with frailty at 3- or 12-month follow-up, 61% were not frail at baseline. Transition to a worse frailty state occurred in 242 of 530 of patients (46%) between baseline and 3 months and in 179 of 445 of patients (40%) between baseline and 12 months. There were 376 patients with frailty, disability, or cognitive impairment at 3-month follow-up. Of these, 53 (14%) had frailty alone. At 12 months, 276 patients had frailty, disability, or cognitive impairment, 37 (13%) of whom had frailty alone. CONCLUSIONS: Frailty is common among survivors of critical illness. In the majority, frailty is newly acquired. Roughly one in seven had frailty without co-occurring disability or cognitive impairment. Studies to understand outcomes of frailty that develops as the result of a critical illness and to identify modifiable risk factors for this potentially reversible syndrome are needed.
OBJECTIVES: Little is known about frailty that develops following critical illness. We sought to describe the prevalence of newly acquired frailty, its clinical course, and the co-occurrence of frailty with disability and cognitive impairment in survivors of critical illness. DESIGN: Longitudinal prospective cohort study. SETTING: Medical and surgical ICUs at five U.S. centers. PATIENTS: Adult patients treated for respiratory failure and/or shock. MEASUREMENTS AND MAIN RESULTS: We measured frailty with the Clinical Frailty Scale at baseline (i.e., study enrollment) and at 3 and 12 months postdischarge. We constructed alluvial diagrams to describe the course of frailty and Venn diagrams to describe the overlap of frailty with disability in activities of daily living and cognitive impairment. We included 567 participants a median (interquartile range) of 61 years old (51-70 yr old) with a high severity of illness (Acute Physiology and Chronic Health Evaluation II of 23). Frailty (Clinical Frailty Scale scores ≥ 5) was present in 135 of 567 (24%) at baseline, 239 of 530 (45%) at 3 months, and 163 of 445 (37%) at 12 months. Of those with frailty at 3- or 12-month follow-up, 61% were not frail at baseline. Transition to a worse frailty state occurred in 242 of 530 of patients (46%) between baseline and 3 months and in 179 of 445 of patients (40%) between baseline and 12 months. There were 376 patients with frailty, disability, or cognitive impairment at 3-month follow-up. Of these, 53 (14%) had frailty alone. At 12 months, 276 patients had frailty, disability, or cognitive impairment, 37 (13%) of whom had frailty alone. CONCLUSIONS: Frailty is common among survivors of critical illness. In the majority, frailty is newly acquired. Roughly one in seven had frailty without co-occurring disability or cognitive impairment. Studies to understand outcomes of frailty that develops as the result of a critical illness and to identify modifiable risk factors for this potentially reversible syndrome are needed.
Authors: Sean M Bagshaw; H Thomas Stelfox; Robert C McDermid; Darryl B Rolfson; Ross T Tsuyuki; Nadia Baig; Barbara Artiuch; Quazi Ibrahim; Daniel E Stollery; Ella Rokosh; Sumit R Majumdar Journal: CMAJ Date: 2013-11-25 Impact factor: 8.262
Authors: Mitchell M Levy; Mitchell P Fink; John C Marshall; Edward Abraham; Derek Angus; Deborah Cook; Jonathan Cohen; Steven M Opal; Jean-Louis Vincent; Graham Ramsay Journal: Crit Care Med Date: 2003-04 Impact factor: 7.598
Authors: L P Fried; C M Tangen; J Walston; A B Newman; C Hirsch; J Gottdiener; T Seeman; R Tracy; W J Kop; G Burke; M A McBurnie Journal: J Gerontol A Biol Sci Med Sci Date: 2001-03 Impact factor: 6.053
Authors: Kenneth Rockwood; Xiaowei Song; Chris MacKnight; Howard Bergman; David B Hogan; Ian McDowell; Arnold Mitnitski Journal: CMAJ Date: 2005-08-30 Impact factor: 8.262
Authors: Daniel W Belsky; Avshalom Caspi; Renate Houts; Harvey J Cohen; David L Corcoran; Andrea Danese; HonaLee Harrington; Salomon Israel; Morgan E Levine; Jonathan D Schaefer; Karen Sugden; Ben Williams; Anatoli I Yashin; Richie Poulton; Terrie E Moffitt Journal: Proc Natl Acad Sci U S A Date: 2015-07-06 Impact factor: 11.205
Authors: Julien Cobert; Sun Young Jeon; John Boscardin; Allyson C Chapman; Lauren E Ferrante; Sei Lee; Alexander K Smith Journal: Chest Date: 2022-01-11 Impact factor: 10.262
Authors: Elizabeth Smith; Max Thomas; Ebru Calik-Kutukcu; Irene Torres-Sánchez; Maria Granados-Santiago; Juan Carlos Quijano-Campos; Karl Sylvester; Chris Burtin; Andreja Sajnic; Jana De Brandt; Joana Cruz Journal: ERJ Open Res Date: 2021-02-08
Authors: Mel E Major; Daniela Dettling-Ihnenfeldt; Stephan P J Ramaekers; Raoul H H Engelbert; Marike van der Schaaf Journal: Crit Care Date: 2021-08-05 Impact factor: 9.097
Authors: Michelle E Kho; Oleksa G Rewa; J Gordon Boyd; Karen Choong; Graeme C H Stewart; Margaret S Herridge Journal: Can J Anaesth Date: 2022-01-31 Impact factor: 6.713