Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study.
Aged, 80 and over
Frailty
Intensive care units
Mortality
Prospective studies
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
01 07 2021
01 07 2021
Historique:
received:
25
04
2021
accepted:
06
06
2021
entrez:
2
7
2021
pubmed:
3
7
2021
medline:
21
10
2021
Statut:
epublish
Résumé
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. 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. 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). 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).
Sections du résumé
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).
Identifiants
pubmed: 34210358
doi: 10.1186/s13054-021-03632-3
pii: 10.1186/s13054-021-03632-3
pmc: PMC8247215
doi:
Banques de données
ClinicalTrials.gov
['NCT03134807', 'NCT03370692']
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
231Investigateurs
R Schmutz
(R)
F Wimmer
(F)
P Eller
(P)
M Joannidis
(M)
P De Buysscher
(P)
N De Neve
(N)
S Oeyen
(S)
W Swinnen
(W)
B Bollen Pinto
(B)
P Abraham
(P)
L Hergafi
(L)
J C Schefold
(JC)
E Biskup
(E)
P Piza
(P)
I Taliadoros
(I)
J Fjølner
(J)
N Dey
(N)
C Sølling
(C)
B S Rasmussen
(BS)
S Christensen
(S)
X Forceville
(X)
G Besch
(G)
H Mentec
(H)
P Michel
(P)
P Mateu
(P)
P Michel
(P)
L Vettoretti
(L)
J Bourenne
(J)
N Marin
(N)
M Guillot
(M)
N Aissaoui
(N)
C Goulenok
(C)
N Thieulot-Rolin
(N)
J Messika
(J)
L Lamhaut
(L)
B Guidet
(B)
C Charron
(C)
A Lauten
(A)
A L Sacher
(AL)
T Brenner
(T)
M Franz
(M)
F Bloos
(F)
H Ebelt
(H)
S J Schaller
(SJ)
K Fuest
(K)
C Rabe
(C)
T Dieck
(T)
S Steiner
(S)
T Graf
(T)
A M Nia
(AM)
C Jung
(C)
R A Janosi
(RA)
P Meybohm
(P)
P Simon
(P)
S Utzolino
(S)
T Rahmel
(T)
E Barth
(E)
C Jung
(C)
M Schuster
(M)
Z Aidoni
(Z)
S Aloizos
(S)
P Tasioudis
(P)
K Lampiri
(K)
V Zisopoulou
(V)
I Ravani
(I)
E Pagaki
(E)
A Antoniou
(A)
T A Katsoulas
(TA)
A Kounougeri
(A)
G Marinakis
(G)
F Tsimpoukas
(F)
A Spyropoulou
(A)
P Zygoulis
(P)
A Kyparissi
(A)
M Gupta
(M)
M Gurjar
(M)
I M Maji
(IM)
I Hayes
(I)
B Marsh
(B)
Y Kelly
(Y)
A Westbrook
(A)
G Fitzpatrick
(G)
D Maheshwari
(D)
C Motherway
(C)
G Negri
(G)
S Spadaro
(S)
G Nattino
(G)
M Pedeferri
(M)
A Boscolo
(A)
S Rossi
(S)
G Calicchio
(G)
L Cubattoli
(L)
G Di Lascio
(G)
M Barbagallo
(M)
F Berruto
(F)
D Codazzi
(D)
A Bottazzi
(A)
P Fumagalli
(P)
G Negro
(G)
G Lupi
(G)
F Savelli
(F)
G A Vulcano
(GA)
R Fumagalli
(R)
A Marudi
(A)
U Lefons
(U)
R Lembo
(R)
M Babini
(M)
A Paggioro
(A)
V Parrini
(V)
M Zaccaria
(M)
S Clementi
(S)
C Gigliuto
(C)
F Facondini
(F)
S Pastorini
(S)
S Munaron
(S)
I Calamai
(I)
A Bocchi
(A)
A Adorni
(A)
M G Bocci
(MG)
A Cortegiani
(A)
T Casalicchio
(T)
S Mellea
(S)
E Graziani
(E)
M Barattini
(M)
E Brizio
(E)
M Rossi
(M)
M Hahn
(M)
H Flaatten
(H)
N Kemmerer
(N)
H F Strietzel
(HF)
K Dybwik
(K)
T Legernaes
(T)
P Klepstad
(P)
E B Olaussen
(EB)
K I Olsen
(KI)
O M Brresen
(OM)
G Bjorsvik
(G)
F H Andersen
(FH)
S Maini
(S)
L Fehrle
(L)
M Czuczwar
(M)
P Krawczyk
(P)
M Ziętkiewicz
(M)
Ł R Nowak
(ŁR)
K Kotfis
(K)
K Cwyl
(K)
R Gajdosz
(R)
J Biernawska
(J)
R Bohatyrewicz
(R)
R Gawda
(R)
P Grudzień
(P)
P Nasiłowski
(P)
N Popek
(N)
W Cyrankiewicz
(W)
K Wawrzyniak
(K)
M Wnuk
(M)
D Maciejewski
(D)
D Studzińska
(D)
M Żukowski
(M)
S Bernas
(S)
M Piechota
(M)
W Szczeklik
(W)
I Nowak-Kózka
(I)
J Fronczek
(J)
M Serwa
(M)
W Machała
(W)
J Stefaniak
(J)
M Wujtewicz
(M)
P Maciejewski
(P)
M Szymkowiak
(M)
B Adamik
(B)
K Polok
(K)
J Górka
(J)
N Catorze
(N)
M C Branco
(MC)
N Barros
(N)
I Barros
(I)
A Krystopchuk
(A)
T Honrado
(T)
C Sousa
(C)
F Munoz
(F)
M Rebelo
(M)
R Gomes
(R)
J Nunes
(J)
C Dias
(C)
A M Fernandes
(AM)
C Petrisor
(C)
B Constantin
(B)
V Belskiy
(V)
B Boskholov
(B)
E Rodriguez
(E)
G Aguilar
(G)
G Masdeu
(G)
M I Jaimes
(MI)
A P Mira
(AP)
M A Bodi
(MA)
J A B Mendoza
(JAB)
S López-Cuenca
(S)
M H Guzman
(MH)
J Rico-Feijoo
(J)
M Ibarz
(M)
J Trenado Alvarez
(JT)
R Kawati
(R)
J Sivik
(J)
J Nauska
(J)
D Smole
(D)
F Parenmark
(F)
J Lyrén
(J)
K Rockstroh
(K)
S Rydén
(S)
M Spångfors
(M)
M Strinnholm
(M)
S Walther
(S)
L De Geer
(L)
P Nordlund
(P)
S Pålsson
(S)
H Zetterquist
(H)
A Nilsson
(A)
K Thiringer
(K)
M Jungner
(M)
B Bark
(B)
B Nordling
(B)
H Sköld
(H)
C Brorsson
(C)
S Persson
(S)
A Bergström
(A)
J Berkius
(J)
J Holmström
(J)
I van Dijk
(I)
L E M van Lelyveld-Haas
(LEM)
T Jansen
(T)
F Nooteboom
(F)
P H J van der Voort
(PHJ)
D de Lange
(D)
W Dieperink
(W)
M C de Waard
(MC)
A G E de Smet
(AGE)
L Bormans
(L)
T Dormans
(T)
G Dempsey
(G)
S J Mathew
(SJ)
A S Raj
(AS)
I Grecu
(I)
J Cupitt
(J)
T Lawton
(T)
R Clark
(R)
M Popescu
(M)
N Spittle
(N)
M Faulkner
(M)
A Cowton
(A)
P Williams
(P)
E Elloway
(E)
M Reay
(M)
S Chukkambotla
(S)
R Kumar
(R)
N Al-Subaie
(N)
L Kent
(L)
T Tamm
(T)
I Kajtor
(I)
K Burns
(K)
R Pugh
(R)
M Ostermann
(M)
E Kam
(E)
H Bowyer
(H)
N Smith
(N)
M Templeton
(M)
J Henning
(J)
K Goffin
(K)
R Kapoor
(R)
S Laha
(S)
P Chilton
(P)
W Khaliq
(W)
A Crayford
(A)
S Coetzee
(S)
M Tait
(M)
W Stoker
(W)
M Gimenez
(M)
A Pope
(A)
J Camsooksai
(J)
D Pogson
(D)
K Quigley
(K)
J Ritzema
(J)
A Hormis
(A)
C Boulanger
(C)
M Balasubramaniam
(M)
L Vamplew
(L)
K Burt
(K)
D Martin
(D)
I Grecu
(I)
J Craig
(J)
J Prowle
(J)
N Doyle
(N)
J Shelton
(J)
C Scott
(C)
P Donnison
(P)
S Shelton
(S)
C Frey
(C)
C Ryan
(C)
D Spray
(D)
C Ryan
(C)
V Barnes
(V)
K Barnes
(K)
S Ridgway
(S)
R Saha
(R)
L Kent
(L)
T Clark
(T)
J Wood
(J)
C Bolger
(C)
C Bassford
(C)
A Cowton
(A)
J Lewandowski
(J)
X Zhao
(X)
S Humphreys
(S)
S Dowling
(S)
N Richardson
(N)
A Burtenshaw
(A)
C Stevenson
(C)
D Wilcock
(D)
Y Nalapko
(Y)
M Joannidis
(M)
P Eller
(P)
R Helbok
(R)
R Schmutz
(R)
J Nollet
(J)
N de Neve
(N)
P De Buysscher
(P)
S Oeyen
(S)
W Swinnen
(W)
M Mikačić
(M)
A Bastiansen
(A)
A Husted
(A)
B E S Dahle
(BES)
C Cramer
(C)
C Sølling
(C)
D Ørsnes
(D)
J Edelberg Thomsen
(JE)
J J Pedersen
(JJ)
M Hummelmose Enevoldsen
(MH)
T Elkmann
(T)
A Kubisz-Pudelko
(A)
A Pope
(A)
A Collins
(A)
A S Raj
(AS)
C Boulanger
(C)
C Frey
(C)
C Hart
(C)
C Bolger
(C)
D Spray
(D)
G Randell
(G)
H Filipe
(H)
I D Welters
(ID)
I Grecu
(I)
J Evans
(J)
J Cupitt
(J)
J Lord
(J)
J Henning
(J)
J Jones
(J)
J Ball
(J)
J North
(J)
K Salaunkey
(K)
L Ortiz-Ruiz De Gordoa
(LO)
L Bell
(L)
M Balasubramaniam
(M)
M Vizcaychipi
(M)
M Faulkner
(M)
M Mupudzi
(M)
M Lea-Hagerty
(M)
M Reay
(M)
M Spivey
(M)
N Love
(N)
N Spittle
(N)
N White
(N)
P Williams
(P)
P Morgan
(P)
P Wakefield
(P)
R Savine
(R)
R Jacob
(R)
R Innes
(R)
R Kapoor
(R)
S Humphreys
(S)
S Rose
(S)
S Dowling
(S)
S Leaver
(S)
T Mane
(T)
T Lawton
(T)
V Ogbeide
(V)
W Khaliq
(W)
Y Baird
(Y)
A Romen
(A)
A Galbois
(A)
B Guidet
(B)
C Vinsonneau
(C)
C Charron
(C)
D Thevenin
(D)
E Guerot
(E)
G Besch
(G)
G Savary
(G)
H Mentec
(H)
J L Chagnon
(JL)
J P Rigaud
(JP)
J P Quenot
(JP)
J Castaneray
(J)
J Rosman
(J)
J Maizel
(J)
K Tiercelet
(K)
L Vettoretti
(L)
M M Hovaere
(MM)
M Messika
(M)
M Djibré
(M)
N Rolin
(N)
P Burtin
(P)
P Garcon
(P)
S Nseir
(S)
X Valette
(X)
C Rabe
(C)
E Barth
(E)
H Ebelt
(H)
K Fuest
(K)
M Franz
(M)
M Horacek
(M)
M Schuster
(M)
P Meybohm
(P)
R Romano Bruno
(RR)
S Allgäuer
(S)
S Dubler
(S)
S J Schaller
(SJ)
S Schering
(S)
S Steiner
(S)
T Dieck
(T)
T Rahmel
(T)
T Graf
(T)
A Koutsikou
(A)
A Vakalos
(A)
B Raitsiou
(B)
E N Flioni
(EN)
E Neou
(E)
F Tsimpoukas
(F)
G Papathanakos
(G)
G Marinakis
(G)
I Koutsodimitropoulos
(I)
K Aikaterini
(K)
N Rovina
(N)
S Kourelea
(S)
T Polychronis
(T)
V Zidianakis
(V)
V Konstantinia
(V)
Z Aidoni
(Z)
B Marsh
(B)
C Motherway
(C)
C Read
(C)
I Martin-Loeches
(I)
A Neville Cracchiolo
(AN)
A Morigi
(A)
I Calamai
(I)
S Brusa
(S)
A Elhadi
(A)
A Tarek
(A)
A Khaled
(A)
H Ahmed
(H)
W Ali Belkhair
(WA)
A D Cornet
(AD)
D Gommers
(D)
D de Lange
(D)
E van Boven
(E)
J Haringman
(J)
L Haas
(L)
L van den Berg
(L)
O Hoiting
(O)
P de Jager
(P)
R T Gerritsen
(RT)
T Dormans
(T)
W Dieperink
(W)
A Breidablik
(A)
A Slapgard
(A)
A K Rime
(AK)
B Jannestad
(B)
B Sjøbøe
(B)
E Rice
(E)
F H Andersen
(FH)
H F Strietzel
(HF)
J P Jensen
(JP)
J Langørgen
(J)
K Tøien
(K)
K Strand
(K)
M Hahn
(M)
P Klepstad
(P)
A Biernacka
(A)
A Kluzik
(A)
B Kudlinski
(B)
D Maciejewski
(D)
D Studzińska
(D)
H Hymczak
(H)
J Stefaniak
(J)
J Solek-Pastuszka
(J)
J Zorska
(J)
K Cwyl
(K)
Ł J Krzych
(ŁJ)
M Zukowski
(M)
M Lipińska-Gediga
(M)
M Pietruszko
(M)
M Piechota
(M)
M Serwa
(M)
M Czuczwar
(M)
M Ziętkiewicz
(M)
N Kozera
(N)
P Nasiłowski
(P)
P Sendur
(P)
P Zatorski
(P)
P Galkin
(P)
R Gawda
(R)
U Kościuczuk
(U)
W Cyrankiewicz
(W)
W Gola
(W)
A F Pinto
(AF)
A M Fernandes
(AM)
A R Santos
(AR)
C Sousa
(C)
I Barros
(I)
I A Ferreira
(IA)
J B Blanco
(JB)
J T Carvalho
(JT)
J Maia
(J)
N Candeias
(N)
N Catorze
(N)
V Belskiy
(V)
A Lores
(A)
A P Mira
(AP)
C Cilloniz
(C)
D Perez-Torres
(D)
E Maseda
(E)
E Rodriguez
(E)
E Prol-Silva
(E)
G Eixarch
(G)
G Gomà
(G)
G Aguilar
(G)
G Navarro Velasco
(GN)
M Irazábal Jaimes
(MI)
M Ibarz Villamayor
(MI)
N Llamas Fernández
(NL)
P Jimeno Cubero
(PJ)
S López-Cuenca
(S)
T Tomasa
(T)
A Sjöqvist
(A)
C Brorsson
(C)
F Schiöler
(F)
H Westberg
(H)
J Nauska
(J)
J Sivik
(J)
J Berkius
(J)
K Kleiven Thiringer
(KK)
L De Geer
(L)
S Walther
(S)
F Boroli
(F)
J C Schefold
(JC)
L Hergafi
(L)
P Eckert
(P)
I Yıldız
(I)
I Yovenko
(I)
Y Nalapko
(Y)
R Pugh
(R)
Références
BMJ. 2006 May 6;332(7549):1080
pubmed: 16675816
Crit Care. 2020 Oct 15;24(1):609
pubmed: 33059749
Crit Care. 2021 Apr 19;25(1):149
pubmed: 33874987
CMAJ. 2005 Aug 30;173(5):489-95
pubmed: 16129869
J Nutr Health Aging. 2009 Apr;13(4):390-4
pubmed: 19300888
Crit Care Med. 2014 Sep;42(9):2037-41
pubmed: 24776607
Ann Intensive Care. 2021 Feb 3;11(1):22
pubmed: 33534010
BMC Geriatr. 2020 Oct 7;20(1):393
pubmed: 33028215
Br J Anaesth. 2021 Mar;126(3):e108-e110
pubmed: 33358046
J Gerontol A Biol Sci Med Sci. 2001 Mar;56(3):M146-56
pubmed: 11253156
Br J Anaesth. 2020 Nov;125(5):704-711
pubmed: 32778405
Br J Anaesth. 2020 Nov;125(5):730-738
pubmed: 32891413
Ann Intensive Care. 2018 Nov 26;8(1):114
pubmed: 30478708
Lancet. 2013 Mar 2;381(9868):752-62
pubmed: 23395245
CMAJ. 2014 Feb 4;186(2):E95-102
pubmed: 24277703
Crit Care Med. 2004 Aug;32(8):1654-61
pubmed: 15286540
Intensive Care Med. 2020 Jan;46(1):57-69
pubmed: 31784798
Ann Intensive Care. 2011 Aug 01;1(1):29
pubmed: 21906383
Br J Anaesth. 2020 Nov;125(5):655-657
pubmed: 32868042
Crit Care. 2017 May 31;21(1):121
pubmed: 28558806
Arch Intern Med. 2012 Mar 26;172(6):467-74
pubmed: 22412076
Intensive Care Med. 2017 Dec;43(12):1820-1828
pubmed: 28936626
Intensive Care Med. 2015 Nov;41(11):1911-20
pubmed: 26306719
Mech Ageing Dev. 2002 Sep;123(11):1457-60
pubmed: 12425952
Intensive Care Med. 1996 Jul;22(7):707-10
pubmed: 8844239
Intensive Care Med. 2017 Sep;43(9):1319-1328
pubmed: 28238055