Association of frailty with short-term outcomes,organ support and resource use in critically ill patients |
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| Authors: | Fernando G. Zampieri Theodore J. Iwashyna Elizabeth M. Viglianti Leandro U. Taniguchi William N. Viana Roberto Costa Thiago D. Corrêa Carlos Eduardo N. Moreira Marcelo O. Maia Giulliana M. Moralez Thiago Lisboa Marcus A. Ferez Carlos Eduardo F. Freitas Clayton B. de Carvalho Bruno F. Mazza Mariza F. A. Lima Grazielle V. Ramos Aline R. Silva Fernando A. Bozza Jorge. I. F. Salluh Marcio Soares for the ORCHESTRA Study Investigators |
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| Affiliation: | 1.Research Institute, HCor-Hospital do Cora??o,S?o Paulo,Brazil;2.Department of Internal Medicine,University of Michigan,Ann Arbor,USA;3.Veterans Affairs Center for Clinical Management Research,HSR&D Center for Excellence,Ann Arbor,USA;4.ICU, Hospital Sírio Libanês,S?o Paulo,Brazil;5.Emergency Medicine Discipline, Hospital das Clínicas HC-FMUSP, Universidade de S?o Paulo,S?o Paulo,Brazil;6.ICU,Hospital Copa D’Or,Rio De Janeiro,Brazil;7.ICU,Hospital Quinta D’Or,Rio De Janeiro,Brazil;8.Adult ICU,Hospital Israelita Albert Einstein,S?o Paulo,Brazil;9.ICU,Hospital Nove de Julho,S?o Paulo,Brazil;10.ICU,Hospital Santa Luzia Rede D’Or S?o Luiz DF,Brasília,Brazil;11.Graduate Program in Translational Medicine and Department of Critical Care,D’Or Institute for Research and Education,Rio De Janeiro,Brazil;12.ICU, Hospital Santa Rita,Santa Casa de Misericórdia de Porto Alegre,Porto Alegre,Brazil;13.ICU,Hospital S?o Francisco,Ribeir?o Preto,Brazil;14.ICU,Hospital Esperan?a Olinda,Olinda,Brazil;15.ICU,Hospital Brasília,Brasília,Brazil;16.ICU,Hospital Samaritano,S?o Paulo,Brazil;17.ICU,Hospital Esperan?a,Recife,Brazil;18.ICU,Hospital Alem?o Oswaldo Cruz,S?o Paulo,Brazil;19.National Institute of Infectious Diseases Evandro Chagas,Oswaldo Cruz Foundation (FIOCRUZ),Rio de Janeiro,Brazil |
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| Abstract: | ![]()
PurposeFrail patients are known to experience poor outcomes. Nevertheless, we know less about how frailty manifests itself in patients’ physiology during critical illness and how it affects resource use in intensive care units (ICU). We aimed to assess the association of frailty with short-term outcomes and organ support used by critically ill patients.MethodsRetrospective analysis of prospective collected data from 93 ICUs in Brazil from 2014 to 2015. We assessed frailty using the modified frailty index (MFI). The primary outcome was in-hospital mortality. Secondary outcomes were discharge home without need for nursing care, ICU and hospital length of stay (LOS), and utilization of ICU organ support and transfusion. We used mixed logistic regression and competing risk models accounting for relevant confounders in outcome analyses.ResultsThe analysis consisted of 129,680 eligible patients. There were 40,779 (31.4%) non-frail (MFI?=?0), 64,407 (49.7%) pre-frail (MFI?=?1–2) and 24,494 (18.9%) frail (MFI?≥?3) patients. After adjusted analysis, frailty was associated with higher in-hospital mortality (OR 2.42, 95% CI 1.89–3.08), particularly in patients admitted with lower SOFA scores. Frail patients were less likely to be discharged home (OR 0.36, 95% CI 0.54–0.79) and had higher hospital and ICU LOS than non-frail patients. Use of all forms of organ support (mechanical ventilation, non-invasive ventilation, vasopressors, dialysis and transfusions) were more common in frail patients and increased as MFI increased.ConclusionsFrailty, as assessed by MFI, was associated with several patient-centered endpoints including not only survival, but also ICU LOS and organ support. |
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