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Available online 26 February 2025
Analysis of frailty as a prognostic factor independent of age: A prospective observational study
Análisis de la fragilidad como factor pronóstico independientemente de la edad: estudio prospectivo observacional
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Rosario Molina Loboa,b,d,
Corresponding author
rosmolinalobo@msn.com

Corresponding author.
, Federico Gordo Vidala,b,d, Lola Prieto Lópezc, Inés Torrejón Péreza, Antonio Naharro Abellána,b, Irene Salinas Gabiñaa, Beatriz Lobo Valbuenaa,b,d
a Intensive Care Unit, Hospital Universitario del Henares, Coslada, Madrid, Spain
b Critical Pathology Researh Group (Grupo de Investigación en Patología Crítica), Facultad de Medicina, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
c Department of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
d Infanta Sofia University Hospital and Henares University Hospital Foundation for Biomedical Research and Innovation (FIIB, HUIS, HUHEN), Madrid, Spain
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Figures (1)
Tables (5)
Table 1. Bivariate analysis of baseline characteristics according to the three frailty categories.
Table 2. Bivariate analysis of organ development during ICU admission by frailty category.
Table 3. Results of multinomial logistic regression model exploring predictors of frailty and prefrailty.
Table 4. Multivariate logistic regression analysis exploring predictors of in-hospital mortality among frail patientsa.
Table 5. Comparison of outcomes of CFS>=4 patients according to age.
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Abstract
Objective

Analyze the effects of frailty and prefrailty in patients admitted to the ICU without age limits and to determine the factors associated with mortality.

Design

Prospective cohort.

Setting

Intensive Care Unit, Spain.

Patients

1462 critically ill patients without age limits.

Intervention

None.

Main variables of interest

Hospital mortality and health outcomes.

Results

Patients’ ages ranged from 15 to 93 years, median of 66 years. Predisposing factors independently associated with frailty and prefrailty were age older than 65 years, female sex, respiratory and renal comorbidities, longer pre-ICU stays, and weekend admission. There is a greater use of noninvasive mechanical ventilation, greater colonization by multidrug-resistant bacteria, and the development of delirium. The risk of hospital mortality was RR 4.04 (2.11–7.74; P<.001) for prefail and 5.88 (2.45–14.10; P<.001) for frail. Factors associated with in-hospital mortality in prefrail and frail were pre-ICU hospital length of stay (cutpoint 4.5 days [1.6–7.4]), greater severity on admission (SAPS3) (cutpoint 64.5 [63.6–65.4]), Glasgow Coma Scale deterioration (OR 4.14 [1.23–13.98]; P .022) and thrombocytopenia (OR 11.46 [2.21–59.42]; P .004).

Conclusions

Lower levels of frailty are most common in ICU patients and are associated with worse health outcomes. Our data suggest that frailty and pre frailty should be determined in all patients admitted to the ICU, regardless of their age.

Keywords:
Critical care
Frail
Frailty
Abbreviations:
CAM-ICU
CFS
CRRT
NIV
SD
GCS
CI
IMV
ICU
IQR
NM blockade
LOS
LSTL
MDR
SAPS 3
SOFA
OF
OR
RR
Vs
Resumen
Objectivo

Analisis del impacto de la fragilidad y prefragilidad en pacientes ​​críticos sin límite de edad y factores de mortalidad hospitalaria.

Diseño

Cohorte prospectivo.

Ámbito

Unidad de Cuidados Intensivos, España.

Pacientes

Pacientes críticos sin límite de edad.

Intervención

Ninguna.

Variables de interés principales

Mortalidad hospitalaria y resultados de salud.

Resultados

El rango de edad fue 15 a 93 años, mediana 66. Los factores asociados con la fragilidad y prefragilidad fueron ser mayor de 65 años, mujer, comorbilidades respiratorias y renales, estancia previa a UCI, ingreso en fin de semana. Existe un mayor riesgo de ventilación mecánica no invasiva, colonización por bacterias multirresistentes, delirium y mortalidad hospitalaria RR 4.04 (2.11–7.74; P<.001) prefrágiles y 5.88 (2.45–14.10; P<.001) en frágiles. Los factores asociados con la mortalidad hospitalaria (prefrágiles y frágiles) fueron los días de estancia previa a UCI (corte 4.5 [1.6–7.4]), mayor gravedad al ingreso (SAPS3) (corte 64.5 [63.6–65.4]), deterioro Escala Glasgow (OR 4.14 [1.23–13.98]; P .022) y trombocitopenia (OR 11.46 [2.21–59.42]; P .004).

Conclusiones

Niveles más bajos de fragilidad son frecuentes en UCI y se asocian a peores resultados de salud. Estos resultados apoyan la identificación de la fragilidad ​​y pre fragilidad en todos los pacientes ingresados en UCI independientemente de la edad.

Palabras clave:
Cuidados intensivos
Frágil
Fragilidad

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