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Title: Impact of frailty on persistent critical illness: a population-based cohort study.
Austin Authors: Darvall, Jai N;Bellomo, Rinaldo ;Bailey, Michael;Young, Paul J;Rockwood, Kenneth;Pilcher, David
Affiliation: Data Analytics Research and Evaluation (DARE) Centre
Department of Intensive Care Medicine, Royal Melbourne Hospital, Grattan St., Parkville, Melbourne, VIC, 3050, Australia..
Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, VIC, Australia..
Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia..
Australian and New Zealand Intensive Care Society, Melbourne, VIC, Australia..
Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia..
Department of Intensive Care, Alfred Hospital, Melbourne, VIC, Australia..
Intensive Care Unit, Wellington Hospital, Wellington, New Zealand..
Medical Research Institute of New Zealand, Wellington, New Zealand..
Divisions of Geriatric Medicine and Neurology, and the Geriatric Medicine Research Unit, Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Nova Scotia Health Authority, Halifax, NS, Canada..
Issue Date: Mar-2022
Date: 2022-02-04
Publication information: Intensive care medicine 2022; 48(3): 343-351
Abstract: Acute illness severity predicts mortality in intensive care unit (ICU) patients, however, its predictive value decreases over time in ICU. Typically after 10 days, pre-ICU (antecedent) characteristics become more predictive of mortality, defining the onset of persistent critical illness (PerCI). How patient frailty affects development and death from PerCI is unknown. We conducted a secondary analysis of data from a prospective binational cohort study including 269,785 critically ill adults from 168 ICUs in Australia and New Zealand, investigating whether frailty measured with the Clinical Frailty Scale (CFS) changes the timing of onset and risk of developing PerCI and of subsequent in-hospital mortality. We assessed associations between frailty (CFS ≥ 5) and mortality prediction using logistic regression and area under the receiver operating characteristics (AUROC) curves. 2190 of 50,814 (4.3%) patients with frailty (CFS ≥ 5) versus 6624 of 218,971 (3%) patients without frailty (CFS ≤ 4) developed PerCI (P < 0.001). Among patients with PerCI, 669 of 2190 (30.5%) with frailty and 1194 of 6624 without frailty (18%) died in hospital (P < 0.001). The time point defining PerCI onset did not vary with frailty degree; however, with increasing length of ICU stay, inclusion of frailty progressively improved mortality discrimination (0.1% AUROC improvement on ICU day one versus 3.6% on ICU day 17). Compared to patients without frailty, those with frailty have a higher chance of developing and dying from PerCI. Moreover the importance of frailty as a predictor of mortality increases with ICU length of stay. Future work should explore incorporation of frailty in prognostic models, particularly for long-staying patients.
DOI: 10.1007/s00134-022-06617-0
ORCID: 0000-0003-0579-8931
Journal: Intensive care medicine
PubMed URL: 35119497
PubMed URL:
Type: Journal Article
Subjects: Frailty
Intensive care unit
Observational study
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