Frailty and Its Association With Catatonia in the Intensive Care Unit: An Analysis of the Delirium and Catatonia Prospective Cohort Study

Background

Frailty is a syndrome characterized by the loss of physiologic reserve and is predictive of subsequent cognitive impairment, disability, and mortality. Catatonia is an underrecognized form of acute brain dysfunction in critical illness.

Objective

To describe association between baseline frailty and catatonia development in the context of critical illness.

Methods

This is a prospective cohort of critically ill adults from a single academic medical center. We included those assessed for pre-existing frailty within 72 hours of study enrollment using the Clinical Frailty Scale. Patients with moderate to severe cognitive impairment at baseline were excluded. Participants were assessed for catatonia using the Bush-Francis Catatonia Rating Scale mapped to Diagnostic and Statistical Manual of Mental Disorders, 5th edition criteria, within the first 14 days of critical illness. To examine the association between baseline frailty and catatonia, we used a chi-square test to evaluate trends in proportions performed for catatonia. To describe measures of association between frailty state along the fitness-frailty continuum and presence of catatonia, we used logistic regression, adjusting for cofounders of interest.

Results

Of 170 patients with a median age of 62 years, 47 (28%) were considered frail and 49 (29%) developed catatonia. In a logistic regression model, frailty was not significantly associated with catatonia presence or absence in the Intensive Care Unit (ICU) (odds ratio = 1.064 [95% confidence interval: 0.805, 1.405], P = 0.664].

Conclusions

Our study did not demonstrate an independent association with increasing levels of frailty along a fitness-frailty continuum and the presence of catatonia. More research is needed to determine if pre-existing frailty may be a predisposing factor for catatonia in the setting of critical illness.