title: Association between frailty and short- and long-term outcomes among critically ill patients: a multicentre prospective cohort study.
abstract: BACKGROUND
  Frailty is a multidimensional syndrome characterized by loss of physiologic and cognitive reserves that confers vulnerability to adverse outcomes. We determined the prevalence, correlates and outcomes associated with frailty among adults admitted to intensive care.
  
  
  METHODS
  We prospectively enrolled 421 critically ill adults aged 50 or more at 6 hospitals across the province of Alberta. The primary exposure was frailty, defined by a score greater than 4 on the Clinical Frailty Scale. The primary outcome measure was in-hospital mortality. Secondary outcome measures included adverse events, 1-year mortality and quality of life.
  
  
  RESULTS
  The prevalence of frailty was 32.8% (95% confidence interval [CI] 28.3%-37.5%). Frail patients were older, were more likely to be female, and had more comorbidities and greater functional dependence than those who were not frail. In-hospital mortality was higher among frail patients than among non-frail patients (32% v. 16%; adjusted odds ratio [OR] 1.81, 95% CI 1.09-3.01) and remained higher at 1 year (48% v. 25%; adjusted hazard ratio 1.82, 95% CI 1.28-2.60). Major adverse events were more common among frail patients (39% v. 29%; OR 1.54, 95% CI 1.01-2.37). Compared with nonfrail survivors, frail survivors were more likely to become functionally dependent (71% v. 52%; OR 2.25, 95% CI 1.03-4.89), had significantly lower quality of life and were more often readmitted to hospital (56% v. 39%; OR 1.98, 95% CI 1.22-3.23) in the 12 months following enrolment.
  
  
  CONCLUSIONS
  Frailty was common among critically ill adults aged 50 and older and identified a population at increased risk of adverse events, morbidity and mortality. Diagnosis of frailty could improve prognostication and identify a vulnerable population that might benefit from follow-up and intervention.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Bagshaw
authors.forename: H Thomas
authors.initials: HT
authors.lastname: Stelfox
authors.forename: Robert C
authors.initials: RC
authors.lastname: McDermid
authors.forename: Darryl B
authors.initials: DB
authors.lastname: Rolfson
authors.forename: Ross T
authors.initials: RT
authors.lastname: Tsuyuki
authors.forename: Nadia
authors.initials: N
authors.lastname: Baig
authors.forename: Barbara
authors.initials: B
authors.lastname: Artiuch
authors.forename: Quazi
authors.initials: Q
authors.lastname: Ibrahim
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Stollery
authors.forename: Ella
authors.initials: E
authors.lastname: Rokosh
authors.forename: Sumit R
authors.initials: SR
authors.lastname: Majumdar
mesh_terms: D000368:Aged; D015331:Cohort Studies; D016638:Critical Illness; D005260:Female; D016330:Frail Elderly; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors