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Vol. 46. Issue 1.
Pages 23-30 (January 2022)
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Vol. 46. Issue 1.
Pages 23-30 (January 2022)
Original
The impact of frailty on mortality in older patients admitted to an Intensive Care Unit
El impacto de la fragilidad sobre la mortalidad de los pacientes ancianos ingresados en la unidad de cuidados intensivos
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L. Pasina,
Corresponding author
laurapasin1704@gmail.com

Corresponding author.
, S. Borasoa, G. Golinoa, B.S. Fakhra, I. Tiberioa, C. Trevisanb
a Department of anesthesia and Intensive Care, Azienda Ospedaliera-Università di Padova, Padua, Italy
b Department of Medicine (DIMED), Geriatric Unit, University of Padova, Italy
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Tables (4)
Table 1. Differences in the characteristics of patients at ICU admission by vital status after a 30-day follow-up.
Table 2. Differences in medical interventions in the sample as a whole and by vital status after a 30-day follow-up.
Table 3. Differences in clinical outcome between frail and non-frail patients.
Table 4. Logistic regression analysis on the association between frailty and, other characteristics of patients at ICU admission and use of ICU advanced procedures with 30-day mortality.
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Additional material (1)
Abstract
Objective

Frailty is a relatively new concept for intensivists, and is defined as a status of increased vulnerability to stressors associated with reduced reserve and function of different physiological systems. Supporting the hypothesis that frailty may be an important predictor of poor prognosis among older patients admitted to Intensive Care Unit (ICU), this study seeks to evaluate the association between frailty at ICU admission and short and long-term mortality.

Design

An unmatched case-control study was carried out.

Setting

Intensive Care Unit.

Patients or participants

Patients80 years of age admitted to the ICU for medical reasons.

Interventions

None.

Main variables of interest

The primary outcome was 30-day mortality, while secondary outcomes were ICU mortality and mortality at one year.

Results

Most of the patients were classified as frail at ICU admission (55.3%). The prevalence of frailty was higher among those who died than in those who were alive within 30 days from ICU admission (62.3% vs 48.3%, p=0.01). One-year mortality was higher in frail (84.4%) than in non-frail patients (65.2%, p<0.001). In the logistic regression analysis, after adjusting for potential confounders such as chronic diseases, clinical complexity, cause of ICU admission and use of advanced procedures, frailty was seen to be significantly associated to one-year mortality, but not with ICU mortality or 30-day mortality.

Discussion

The admission of geriatric patients to the ICU is increasing. Frailty assessment may play an important role in the clinical evaluation of such individuals for triage, but should not be considered a priori as an exclusion criterion for admission.

Keywords:
Mortality
Frailty
Intensive care
Resumen
Objetivo

«Fragilidad» es un concepto relativamente nuevo para los intensivistas, y se define como un estado de mayor vulnerabilidad frente a los estresores asociados con una reducción de las reservas y del funcionamiento de distintos sistemas fisiológicos. Basándose en la hipótesis de que la fragilidad podría ser un importante factor predictivo de un mal pronóstico en pacientes ancianos ingresados en la unidad de cuidados intensivos (UCI), este estudio tenía por objeto evaluar la asociación entre la fragilidad en el momento del ingreso en la UCI y la mortalidad a corto y largo plazo.

Diseño

Estudio de casos y controles sin emparejamiento.

Ámbito

Unidad de cuidados intensivos.

Pacientes o participantes

Pacientes ≥80 años ingresados en la UCI por motivos médicos.

Intervenciones

Ninguna.

Variables de interés principales

La variable principal fue la mortalidad a 30 días, mientras que las variables secundarias fueron la mortalidad en la UCI y al cabo de un año.

Resultados

La mayoría de los pacientes se clasificaron como frágiles en el momento de su ingreso en la UCI (55,3%). La prevalencia de la fragilidad fue más alta entre quienes fallecieron que en el caso de los que seguían con vida a los 30 días de su ingreso en la UCI (62,3% frente al 48,3%; p=0,01). La mortalidad a un año fue más elevada en los pacientes frágiles (84,4%) que en los no frágiles (65,2%; p<0,001). En la regresión logística, tras el ajuste de los posibles factores de confusión, como las enfermedades crónicas, la complejidad clínica, el motivo del ingreso en la UCI y el uso de procedimientos avanzados, la fragilidad resultó estar significativamente asociada con la mortalidad a un año, pero no con la mortalidad en la UCI ni al cabo de 30 días.

Discusión

El ingreso de pacientes geriátricos en la UCI está aumentando con el paso del tiempo. La evaluación de la fragilidad podría desempeñar un papel importante en su evaluación clínica para el triaje, pero no debería considerarse a priori como un criterio de exclusión para el ingreso.

Palabras clave:
Mortalidad
Fragilidad
Cuidados intensivos

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