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Vol. 46. Issue 5.
Pages 239-247 (May 2022)
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Vol. 46. Issue 5.
Pages 239-247 (May 2022)
Original article
Evaluating frailty may complement APACHE II in estimating mortality in elderly patients admitted to the ICU after digestive surgery
La evaluación de la fragilidad puede mejorar la predicción del APACHE II en pacientes ancianos ingresados en UCI tras cirugía digestiva
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P. Ruiz de Gopegui Miguelenaa,
Corresponding author
pablo_ruiz87@hotmail.com

Corresponding author.
, M.T. Martínez Lamazaresa, L.M. Claraco Vegaa, M. Gurpegui Puentea, I. González Almárceguia, P. Gutiérrez Ibañesa, A. Carrillo Lópeza, C.M. Castiella Garcíab, J. Miguelena Hyckac
a Servicio de Medicina Intensiva, Hospital Universitario Miguel Servet, Zaragoza, Spain
b Servicio de Farmacia, Hospital Royo Villanova, Zaragoza, Spain
c Servicio de Cirugía Cardiaca, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Tables (5)
Table 1. Modified Frailty Index.
Table 2. Characteristics of the patients according to their classification by the two frailty scales.
Table 3. Association of the frailty scales to the need for readmission to the ICU, repeat surgery and readmission at 6 months.
Table 4. Comparison of the discriminating capacity (area under the ROC curve [AUROC]) of the APACHE II, CFS, mFI, and of the different models combined.
Table 5. Probability of in-hospital mortality estimated by the model combining APACHE II and CFS.
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Abstract
Objective

To analyze whether frailty can improve the prediction of mortality in patients admitted to the ICU after digestive surgery.

Design

Prospective, observational, 6-month follow-up study of a cohort of patients admitted to the ICU between June 1, 2018, and June 1, 2019.

Setting

Surgical ICU of a third level hospital.

Patients

Series of successive patients older than 70 years who were admitted to the ICU immediately after a surgical intervention on the digestive system. 92 patients were included and 2 were excluded due to loss of follow-up at 6 months.

Interventions

Upon admission to the ICU, severity and prognosis were assessed by APACHE II, and fragility by the Clinical Frailty Scale and the modified Frailty Index.

Main variables of interest

ICU, in-hospital and 6-month mortality.

Results

The model that best predicts mortality in the ICU is the APACHE II, with an area under the ROC curve (AUC) of 0.89 and a good calibration. The model that combines APACHE II and Clinical Frailty Scale is the one that best predicts in-hospital mortality (AUC: 0.82), significantly improving the prediction of isolated APACHE II (AUC: 0.78; Integrated Discrimination Index: 0.04). Frailty is a predictor of mortality at 6 months, being the model that combines Clinical Frailty Scale and Frailty Index the one that has shown the greatest discrimination (AUC: 0.84).

Conclusions

Frailty can complement APACHE II by improving its prediction of hospital mortality. Furthermore, it offers a good prediction of mortality 6 months after surgery. For mortality in ICU, frailty loses its predictive power, whereas isolated APACHE II shows excellent predictive capacity.

Keywords:
Frailty
Sigestive surgery
Intensive Medicine
APACHE II
Mortality
Resumen
Objetivo

Analizar si la fragilidad puede mejorar la predicción de mortalidad en los pacientes ingresados en UCI tras una cirugía digestiva.

Diseño

Estudio prospectivo, observacional y con seguimiento a 6 meses de una cohorte de pacientes que ingresaron en UCI entre el 1 de junio de 2018 hasta el 1 de junio de 2019.

Ámbito

UCI quirúrgica de un hospital de tercer nivel.

Pacientes

Serie de pacientes sucesivos mayores de 70 años que ingresaron en UCI inmediatamente después de una intervención quirúrgica sobre el aparato digestivo. Fueron incluidos 92 pacientes y se excluyeron 2 por pérdida de seguimiento a los 6 meses.

Intervenciones

Al ingreso en UCI se estimó gravedad y pronóstico mediante el APACHE II, y fragilidad mediante la Clinical Frailty Scale y el modified Frailty Index.

Variables de interés principales

Mortalidad en UCI, intrahospitalaria y a los 6 meses.

Resultados

El modelo que mejor predice mortalidad en UCI es el APACHE II, con un área bajo la curva ROC (ABC) de 0,89 y una buena calibración. El modelo que combina APACHE II y Clinical Frailty Scale es el que mejor predice mortalidad intrahospitalaria (ABC: 0,82), mejorando significativamente la predicción del APACHE II aislado (ABC: 0,78; Integrated Discrimination Index: 0,04). La fragilidad es un factor predictor de mortalidad a los 6 meses, siendo el modelo que combina la Clinical Frailty Scale y el modified Frailty Index el que ha demostrado mayor discriminación (ABC: 0,84).

Conclusiones

La fragilidad puede complementar al APACHE II mejorando su predicción de mortalidad hospitalaria. Además, ofrece una buena predicción de la mortalidad a los 6 meses de la cirugía. Para la mortalidad en UCI, la fragilidad pierde su poder de predicción mientras que el APACHE II aislado muestra una excelente capacidad predictiva.

Palabras clave:
Fragilidad
Cirugía general
Medicina intensiva
APACHE II
Mortalidad

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