Association between frailty and short- and long-term outcomes among critically ill patients: a multicentre prospective cohort study

Background:

Frailty is a multidimensional syndrome characterized by loss of physiologic and cognitive reserves that confers vulnerability to adverse outcomes. We determined the prevalence, correlates and outcomes associated with frailty among adults admitted to intensive care.

Methods:

We prospectively enrolled 421 critically ill adults aged 50 or more at 6 hospitals across the province of Alberta. The primary exposure was frailty, defined by a score greater than 4 on the Clinical Frailty Scale. The primary outcome measure was in-hospital mortality. Secondary outcome measures included adverse events, 1-year mortality and quality of life.

Results:

The prevalence of frailty was 32.8% (95% confidence interval [CI] 28.3%–37.5%). Frail patients were older, were more likely to be female, and had more comorbidities and greater functional dependence than those who were not frail. In-hospital mortality was higher among frail patients than among non-frail patients (32% v. 16%; adjusted odds ratio [OR] 1.81, 95% CI 1.09–3.01) and remained higher at 1 year (48% v. 25%; adjusted hazard ratio 1.82, 95% CI 1.28–2.60). Major adverse events were more common among frail patients (39% v. 29%; OR 1.54, 95% CI 1.01–2.37). Compared with nonfrail survivors, frail survivors were more likely to become functionally dependent (71% v. 52%; OR 2.25, 95% CI 1.03–4.89), had significantly lower quality of life and were more often readmitted to hospital (56% v. 39%; OR 1.98, 95% CI 1.22–3.23) in the 12 months following enrolment.

Interpretation:

Frailty was common among critically ill adults aged 50 and older and identified a population at increased risk of adverse events, morbidity and mortality. Diagnosis of frailty could improve prognostication and identify a vulnerable population that might benefit from follow-up and intervention.Frailty is a term widely used to describe a multidimensional syndrome characterized by the loss of physiologic and cognitive reserves that gives rise to heightened vulnerability to adverse outcomes.^1,2 Adverse events associated with frailty include incident falls, susceptibility to acute illness, perioperative complications, unplanned hospital admissions, disability, need for institutional care, and death.^3–10 Frailty has substantial implications for quality of life, functional autonomy and health services utilization, but it has not been evaluated in critically ill patients.The development of critical illness may lead to frailty in vulnerable patients. Critical illness may also be a key factor impeding recovery and functional autonomy in those already considered to be frail.¹¹ We hypothesized that frailty would identify vulnerable patients who are less likely to tolerate critical illness, who are more susceptible to complications and death, and who are less likely to fully recover after critical illness over the short or long term. We further hypothesized that this information would translate into more accurate prognostication, which might improve decision-making for frail patients and their families. To test these hypotheses, we performed a prospective multicentre study in an unselected cohort of critically ill patients.