Raphael Romano Bruno1, Bernhard Wernly2, Michael Beil3, Johanna M Muessig1, Tim Rahmel4, Tobias Graf5, Patrick Meybohm6, Stefan J Schaller7, Sebastian Allgäuer8, Marcus Franz9, Julian Georg Westphal10, Eberhard Barth11, Henning Ebelt12, Kristina Fuest13, Michael Horacek14, Michael Schuster15, Simon Dubler16, Stefan Schering17, Georg Wolff1, Stephan Steiner18, Christian Rabe19, Thorben Dieck20, Alexander Lauten21, Anne Lena Sacher22, Thorsten Brenner23, Frank Bloos24, Rolf A Jánosi25, Philipp Simon26, Stefan Utzolino27, Malte Kelm28, Dylan W De Lange29, Bertrand Guidet30, Hans Flaatten31, Christian Jung32. 1. Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Germany. 2. Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Austria; Division of Cardiology, Department of Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden. 3. Medical Intensive Care Unit, Hadassah University Hospital, En Kerem, Jerusalem, Israel. Electronic address: beil@doctors.org.uk. 4. Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany. Electronic address: tim.rahmel@rub.de. 5. University Heart Center Luebeck, Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital Schleswig-Holstein, Luebeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Luebeck, Germany. Electronic address: Tobias.Graf@uksh.de. 6. Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt/Main, Germany; Department of Anaesthesiology, University Hospital Wuerzburg, Wuerzburg, Germany. Electronic address: Meybohm_P@ukw.de. 7. Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Anesthesiology and Surgical Intensive Care, Berlin, Germany. Electronic address: stefan.schaller@charite.de. 8. Robert-Bosch-Hospital, Department for Cardiology, Stuttgart, Germany. Electronic address: Sebastian.Allgaeuer@rbk.de. 9. Department of Internal Medicine I, University Hospital Jena, Friedrich Schiller University, Jena, Germany. 10. Department of Internal Medicine I, University Hospital Jena, Friedrich Schiller University, Jena, Germany. Electronic address: Julian.Westphal@med.uni-jena.de. 11. Division of Intensive Care Medicine, Department of Anesthesiology, University Hospital Ulm, Ulm, Germany. Electronic address: eberhard.barth@uni-ulm.de. 12. Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Erfurt, Germany. Electronic address: kardiologie@kkh-erfurt.de. 13. Department of Anesthesiology and Intensive Care, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany. Electronic address: kristina.fuest@tum.de. 14. Clinic of Cardiology, Alfried Krupp Hospital, Essen, Germany. Electronic address: michael.horacek@krupp-krankenhaus.de. 15. Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Mainz, Mainz, Germany. Electronic address: michael.schuster@unimedizin-mainz.de. 16. Department of Anesthesiology and Intensive Care Medicine, Heidelberg University Hospital, Heidelberg, Germany. Electronic address: simon.dubler@med.uni-heidelberg.de. 17. Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, Germany. Electronic address: stefan.schering@medizin.uni-leipzig.de. 18. Department of Cardiology, Pneumology and Intensive Care Medicine, St Vincenz Hospital Limburg, Auf dem Schafsberg, 65549 Limburg, Germany. Electronic address: s.steiner@st-vincenz.de. 19. Department of Clinical Toxicology, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany. Electronic address: christian.rabe@mri.tum.de. 20. Department of Anesthesiology and Intensive Care, Hannover Medical School, Hannover, Germany. Electronic address: dieck.thorben@mh-hannover.de. 21. Department of Cardiology, Helios Klinikum Erfurt, Erfurt, Germany. Electronic address: alexander.lauten@charite.de. 22. Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Anesthesiology and Surgical Intensive Care, Berlin, Germany. 23. Department of Anesthesiology and Intensive Care Medicine, Heidelberg University Hospital, Heidelberg, Germany. Electronic address: thorsten.brenner@med.uni-heidelberg.de. 24. Department of Anaesthesiology and Intensive Care Medicine, University Hospital Jena, Jena, Germany. Electronic address: Frank.Bloos@med.uni-jena.de. 25. Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany. Electronic address: alexander.janosi@uk-essen.de. 26. Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, Germany. Electronic address: philipp.simon@medizin.uni-leipzig.de. 27. Department of General and Visceral Surgery, University Hospital Freiburg, Freiburg, Germany. Electronic address: stefan.utzolino@uniklinik-freiburg.de. 28. Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Germany; Cardiovascular Research Institute Düsseldorf (CARID), Düsseldorf, Germany. 29. Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands. Electronic address: D.W.deLange@umcutrecht.nl. 30. Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Saint Antoine Hospital, AP-HP, Hôpital Saint-Antoine, Service de Réanimation, F75012 Paris, France. Electronic address: bertrand.guidet@aphp.fr. 31. Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway. Electronic address: Hans.Flaatten@uib.no. 32. Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Germany. Electronic address: Christian.Jung@med.uni-duesseldorf.de.
Abstract
PURPOSE: The approach to limit therapy in very old intensive care unit patients (VIPs) significantly differs between regions. The focus of this multicenter analysis is to illuminate, whether the Clinical Frailty Scale (CFS) is a suitable tool for risk stratification in VIPs admitted to intensive care units (ICUs) in Germany. Furthermore, this investigation elucidates the impact of therapeutic limitation on the length of stay and mortality in this setting. METHODS: German cohorts' data from two multinational studies (VIP-1, VIP-2) were combined. Univariate and multivariate logistic regression were used to evaluate associations with mortality. RESULTS: 415 acute VIPs were included. Frail VIPs (CFS > 4) were older (85 [IQR 82-88] vs. 83 [IQR 81-86] years p < .001) and suffered from an increased 30-day-mortality (43.4% versus 23.9%, p < .0001). CFS was an independent predictor of 30-day-mortality in a multivariate logistic regression model (aOR 1.23 95%CI 1.04-1.46 p = .02). Patients with any limitation of life-sustaining therapy had a significantly increased 30-day mortality (86% versus 16%, p < .001) and length of stay (144 [IQR 72-293] versus 96 [IQR 47.25-231.5] hours, p = .026). CONCLUSION: In German ICUs, any limitation of life-sustaining therapy in VIPs is associated with a significantly increased ICU length of stay and mortality. CFS reliably predicts the outcome.
PURPOSE: The approach to limit therapy in very old intensive care unit patients (VIPs) significantly differs between regions. The focus of this multicenter analysis is to illuminate, whether the Clinical Frailty Scale (CFS) is a suitable tool for risk stratification in VIPs admitted to intensive care units (ICUs) in Germany. Furthermore, this investigation elucidates the impact of therapeutic limitation on the length of stay and mortality in this setting. METHODS: German cohorts' data from two multinational studies (VIP-1, VIP-2) were combined. Univariate and multivariate logistic regression were used to evaluate associations with mortality. RESULTS: 415 acute VIPs were included. Frail VIPs (CFS > 4) were older (85 [IQR 82-88] vs. 83 [IQR 81-86] years p < .001) and suffered from an increased 30-day-mortality (43.4% versus 23.9%, p < .0001). CFS was an independent predictor of 30-day-mortality in a multivariate logistic regression model (aOR 1.23 95%CI 1.04-1.46 p = .02). Patients with any limitation of life-sustaining therapy had a significantly increased 30-day mortality (86% versus 16%, p < .001) and length of stay (144 [IQR 72-293] versus 96 [IQR 47.25-231.5] hours, p = .026). CONCLUSION: In German ICUs, any limitation of life-sustaining therapy in VIPs is associated with a significantly increased ICU length of stay and mortality. CFS reliably predicts the outcome.
Authors: Hans Flaatten; Bertrand Guidet; Dylan W de Lange; Michael Beil; Susannah K Leaver; Jesper Fjølner; Peter Vernon van Heerden; Sviri Sigal; Wojciech Szczeklik; Christian Jung Journal: J Crit Care Date: 2021-11-12 Impact factor: 3.425