Jakub Fronczek1, Kamil Polok1, Dylan W de Lange2, Christian Jung3, Michael Beil4, Andrew Rhodes5, Jesper Fjølner6, Jacek Górka1, Finn H Andersen7,8, Antonio Artigas9, Maurizio Cecconi10,11, Steffen Christensen6, Michael Joannidis12, Susannah Leaver13, Brian Marsh14, Alessandro Morandi15, Rui Moreno16, Sandra Oeyen17, Christina Agvald-Öhman18, Bernardo Bollen Pinto19, Joerg C Schefold20, Andreas Valentin21, Sten Walther22, Ximena Watson5, Tilemachos Zafeiridis23, Sigal Sviri24, Peter Vernon van Heerden25, Hans Flaatten26,27, Bertrand Guidet28, Wojciech Szczeklik29. 1. Department of Medicine, Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, ul. Skawińska 8, 31 - 066, Kraków, Poland. 2. Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands. 3. Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany. 4. Medical Intensive Care Unit, Hadassah Medical Center, Jerusalem, Israel. 5. St George's University Hospitals NHS Foundation Trust, London, London, UK. 6. Department of Intensive Care, Aarhus University Hospital, Århus, Denmark. 7. Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway. 8. Department of Circulation and Medical Imaging, NTNU, Trondheim, Norway. 9. Critical Care Department, Corporacion Sanitaria Universitaria Parc Tauli, CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, Sabadell, Spain. 10. Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center - IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy. 11. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Rozzano, MI, Italy. 12. Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria. 13. Research Lead Critical Care Directorate St George's Hospital, London, UK. 14. Mater Misericordiae University Hospital, Dublin, Ireland. 15. Department of Rehabilitation Hospital Ancelle di Cremona Italy, Geriatric Research Group, Brescia, Italy. 16. Faculdade de Ciências Médicas de Lisboa (Nova Médical School), Unidade de Cuidados Intensivos Neurocríticos e Trauma, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal. 17. Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium. 18. Karolinska University Hospital, Stockholm, Sweden. 19. Department of Anaesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland. 20. Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. 21. Kardinal Schwarzenberg Hospital, Schwarzach, Austria. 22. Department of Cardiothoracic Surgery, Anesthesia and Intensive Care, Linköping University Hospital and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. 23. Intensive Care Unit, General Hospital of Larissa, Larissa, Greece. 24. Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel. 25. Department of Anesthesia, Intensive Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel. 26. Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway. 27. Department of Clinical Medicine, University of Bergen, Bergen, Norway. 28. UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: Epidémiologie Hospitalière Qualité et Organisation des Soins, Sorbonne Universités, Assistance Publique - Hôpitaux de Paris, 75012, Paris, France. 29. Department of Medicine, Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, ul. Skawińska 8, 31 - 066, Kraków, Poland. wojciech.szczeklik@uj.edu.pl.
Abstract
BACKGROUND: The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context. METHODS: We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients ≥ 80 years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patient's age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score. RESULTS: The median age in the sample of 7487 consecutive patients was 84 years (IQR 81-87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p < 0.001). The relationship between the CFS score and mortality was nonlinear (p < 0.01). CONCLUSION: Knowledge about a patient's frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided. Trial registration NCT03134807 (VIP1), NCT03370692 (VIP2).
BACKGROUND: The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context. METHODS: We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients ≥ 80 years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patient's age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score. RESULTS: The median age in the sample of 7487 consecutive patients was 84 years (IQR 81-87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p < 0.001). The relationship between the CFS score and mortality was nonlinear (p < 0.01). CONCLUSION: Knowledge about a patient's frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided. Trial registration NCT03134807 (VIP1), NCT03370692 (VIP2).
Entities:
Keywords:
Aged, 80 and over; Frailty; Intensive care units; Mortality; Prospective studies
Authors: Kamil Polok; Jakub Fronczek; Antonio Artigas; Hans Flaatten; Bertrand Guidet; Dylan W De Lange; Jesper Fjølner; Susannah Leaver; Michael Beil; Sigal Sviri; Raphael Romano Bruno; Bernhard Wernly; Bernardo Bollen Pinto; Joerg C Schefold; Dorota Studzińska; Michael Joannidis; Sandra Oeyen; Brian Marsh; Finn H Andersen; Rui Moreno; Maurizio Cecconi; Christian Jung; Wojciech Szczeklik Journal: Crit Care Date: 2022-07-22 Impact factor: 19.334
Authors: Oded Mousai; Lola Tafoureau; Tamar Yovell; Hans Flaatten; Bertrand Guidet; Christian Jung; Dylan de Lange; Susannah Leaver; Wojciech Szczeklik; Jesper Fjolner; Peter Vernon van Heerden; Leo Joskowicz; Michael Beil; Gal Hyams; Sigal Sviri Journal: Intensive Care Med Date: 2022-09-02 Impact factor: 41.787