Analysis of frailty as a prognostic factor independent of age: A prospective observational study

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.