title: Prevalence and impact of frailty on mortality in elderly ICU patients: a prospective, multicenter, observational study.
abstract: OBJECTIVE
  Frailty is a recent concept used for evaluating elderly individuals. Our study determined the prevalence of frailty in intensive care unit (ICU) patients and its impact on the rate of mortality.
  
  
  METHODS
  A multicenter, prospective, observational study performed in four ICUs in France included 196 patients aged ≥65 years hospitalized for >24 h during a 6-month study period. Frailty was determined using the frailty phenotype (FP) and the clinical frailty score (CFS). The patients were separated as follows: FP score <3 or ≥3 and CFS <5 or ≥5.
  
  
  RESULTS
  Frailty was observed in 41 and 23% of patients on the basis of an FP score ≥3 and a CFS ≥5, respectively. At admission to the ICU, the Simplified Acute Physiology Score II (SAPS II) and Sequential Organ Failure Assessment (SOFA) scores did not differ between the frail and nonfrail patients. In the multivariate analysis, the risk factors for ICU mortality were FP score ≥3 [hazard ratio (HR), 3.3; 95% confidence interval (CI), 1.6-6.6; p < 0.001], male gender (HR, 2.4; 95% CI, 1.1-5.3; p = 0.026), cardiac arrest before admission (HR, 2.8; 95% CI, 1.1-7.4; p = 0.036), SAPS II score ≥46 (HR, 2.6; 95% CI, 1.2-5.3; p = 0.011), and brain injury before admission (HR, 3.5; 95% CI, 1.6-7.7; p = 0.002). The risk factors for 6-month mortality were a CFS ≥5 (HR, 2.4; 95% CI, 1.49-3.87; p < 0.001) and a SOFA score ≥7 (HR, 2.2; 95% CI, 1.35-3.64; p = 0.002). An increased CFS was associated with significant incremental hospital and 6-month mortalities.
  
  
  CONCLUSIONS
  Frailty is a frequent occurrence and is independently associated with increased ICU and 6-month mortalities. Notably, the CFS predicts outcomes more effectively than the commonly used ICU illness scores.
authors.affiliation: Département d'Anesthésie Réanimation, CHU Rennes, Rennes, France.
authors.forename: Pascale
authors.initials: P
authors.lastname: Le Maguet
authors.forename: Antoine
authors.initials: A
authors.lastname: Roquilly
authors.forename: Sigismond
authors.initials: S
authors.lastname: Lasocki
authors.forename: Karim
authors.initials: K
authors.lastname: Asehnoune
authors.forename: Elsa
authors.initials: E
authors.lastname: Carise
authors.forename: Marjorie
authors.initials: M
authors.lastname: Saint Martin
authors.forename: Olivier
authors.initials: O
authors.lastname: Mimoz
authors.forename: Grégoire
authors.initials: G
authors.lastname: Le Gac
authors.forename: Dominique
authors.initials: D
authors.lastname: Somme
authors.forename: Catherine
authors.initials: C
authors.lastname: Cattenoz
authors.forename: Fanny
authors.initials: F
authors.lastname: Feuillet
authors.forename: Yannick
authors.initials: Y
authors.lastname: Malledant
authors.forename: Philippe
authors.initials: P
authors.lastname: Seguin
mesh_terms: D018806:APACHE; D000203:Activities of Daily Living; D000368:Aged; D015897:Comorbidity; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D005602:France / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D053208:Kaplan-Meier Estimate; D008297:Male; D008569:Memory Disorders; D015999:Multivariate Analysis; D063305:Organ Dysfunction Scores; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution