Frailty lowers chances of survival in ICU patients

In critically ill patients admitted to an intensive care unit (ICU), the greater the severity of frailty at baseline, the lower the likelihood of survival, a study reports. As such, frailty should be considered when determining goals-of-care and treatment plans in this population.

The study included 24,499 community-dwelling older adults (aged ≥65 years) who were admitted to an ICU within 180 days of an interRAI-Home Care (RAI-HC) assessment. The RAI-HC was used to calculate frailty measures, including a classification tree version of the Clinical Frailty Scale (CFS); the Frailty Index - Acute Care (FI-AC); and the Changes in Health, End-Stage Disease, Signs, and Symptoms Scale (CHESS).

ICU admission occurred a median of 64 days after the RAI-HC assessment. While in the ICU, 17.4 percent and 9.0 percent of the population were put on mechanical ventilation for ≤96 and >96 hours, respectively.

According to the CFS classification, 11.8 percent, 58.8 percent, 22.4 percent of the patients were living with mild (CFS 5), moderate (CFS 6), or severe frailty (CFS 7), respectively, prior to ICU admission. Likewise, most had FI-AC >0.2. There was a roughly equal distribution of patients among CHESS scores from 0 (no health instability) to 3 (moderate health instability).

Forty-three percent (95 percent confidence interval, 42.4–43.6) survived 1 year after ICU admission. In general, among the overall cohort and both mechanical ventilation subgroups, mortality hazards increased with the severity of baseline frailty.

For predicting survival 30, 90, and 365 days after admission to an ICU, models that adjusted for one of the frailty measures were more discriminant than reference models that adjusted only for age, sex, major clinical category, and area income quintile.

The findings highlight the utility of information collected using routine home care interRAI clinical assessments in obtaining a more reliable estimate of baseline frailty. This should help improve clinical decision-making in the ICU. More studies are needed to evaluate the effect of baseline frailty on outcomes, including change in function and health service utilization after ICU discharge.