Validez y sensibilidad al cambio de la Clinical Frailty Scale-España en pacientes ingresados en cuidados intensivos

Introduction

Frailty scales, developed to assess elderly patients, are being implemented in critically ill patients. One of the most widely used is Clinical Frailty Scale, wrecently adapted to Spanish (CFS-Spain).

Objective

To evaluate the validity and sensitivity to change of the CFS-España in a cohort of critically ill patients aged ≥18 years.

Methodology

A prospective, multicenter, observational, metric-based study was conducted between January-2020 and July-2024. Adult patients with ICU stays >48 hours were included. Follow-up was performed during the stay and up to one year after discharge. Variables: frailty, sociodemographic characteristics, quality of life, comorbidities, severity (SAPS3), ICU outcome variables, length of stay, and discharge destination. Statistical analysis: exploratory, bivariate regression to assess the relationship between frailty and the recorded variables; multivariate regression of significant variables in bivariate. Spearman correlation of CFS-Spain with quantitative variables. Comparison of means with Student's t-test for sensitivity to change.

Results

A total of 493 patients were included, 17.4% of whom were frail (CFS-Spain = 5-9). Age, being female, and being dependent increased the risk of frailty, as did previous hospitalizations, comorbidities, poorer physical quality of life, low academic level, and low annual income. Frailty predicts muscle weakness, hypoglycemia, the need for extrarenal blood pressure, invasive mechanical ventilation, vasoactive drugs, cardiopulmonary resuscitation, or limitation of life-sustaining treatment, and is associated with mortality. Frailty was not associated with mental quality of life, SAPS3, SOFA or ICU/hospital stay. The greatest change observed was between admission and 3 months after discharge. The effect size for changes in CFS-Es between admission, midpoints, and discharge was high (d = 0.832).

Conclusions

The CFS-Spain shows good convergent validity with age, women, dependency, poorer physical quality of life, days of previous hospitalization, academic level and low annual income. Good predictive validity for the level of vital support in ICU, mortality and destination at hospital discharge.