title: Mortality in Relation to Frailty in Patients Admitted to a Specialized Geriatric Intensive Care Unit.
abstract: BACKGROUND
  In older adults admitted to intensive care units (ICUs), frailty influences prognosis. We examined the relationship between the frailty index (FI) based on deficit accumulation and early and late survival.
  
  
  METHODS
  Older patients (≥65 years) admitted to a specialized geriatric ICU at the Liuhuaqiao Hospital, Guangzhou, China between July-December 2011 (n = 155; age 82.7±7.1 y; 87.1% men) were followed for 300 days. The FI was calculated as the proportion present of 52 health deficits. FI performance was compared with that of several prognostic scores.
  
  
  RESULTS
  The 90-day death rate was 38.7% (n = 60; 27 died within 30 days). The FI score was correlated with the Glasgow Coma Scale, Karnofsky Scale, Palliative Performance Scale, Acute Physiology Score-APACHE II and APACHE IV (r (2) = 0.52 to 0.72, p < 0.001). Patients who died within 30 days had higher mean FI scores (0.41±0.11) than those who survived to 300 days (0.22±0.11; F = 38.91, p < 0.001). Each 1% increase in the FI from the previous level was associated with an 11% increase in the 30-day mortality risk (95% CI: 7%-15%) adjusting for age, sex, and the prognostic scores. The FI discriminated patients who died in 30 days from those who survived with moderately high accuracy (AUC = 0.89±0.03). No one with an FI score >0.46 survived past 90 days.
  
  
  CONCLUSIONS
  ICU survival was strongly associated with the level of frailty at admission. An FI based on health deficit accumulation may help improve critical care outcome prediction in older adults.
authors.affiliation: School of Computers, Guangdong University of Technology, Guangzhou, China.
authors.forename: An
authors.initials: A
authors.lastname: Zeng
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. Centre for Healthcare of the Elderly, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada.
authors.forename: Xiaowei
authors.initials: X
authors.lastname: Song
authors.affiliation: Department of Medical Intensive Care Unit, General Hospital of Guangzhou Military Command; Guangdong Provincial Key Laboratory of Geriatric Infection and Organ Function Support and Guangzhou Key Laboratory of Geriatric Infection and Organ Function Support, Guangzhou, China.
authors.forename: Jiahui
authors.initials: J
authors.lastname: Dong
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. Departments of Mathematics and Statistics, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Arnold
authors.initials: A
authors.lastname: Mitnitski
authors.affiliation: Department of Medical Intensive Care Unit, General Hospital of Guangzhou Military Command; Guangdong Provincial Key Laboratory of Geriatric Infection and Organ Function Support and Guangzhou Key Laboratory of Geriatric Infection and Organ Function Support, Guangzhou, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Medical Intensive Care Unit, General Hospital of Guangzhou Military Command; Guangdong Provincial Key Laboratory of Geriatric Infection and Organ Function Support and Guangzhou Key Laboratory of Geriatric Infection and Organ Function Support, Guangzhou, China. Department of Medicine, Southern Medical University, Guangzhou, China. micugzh@126.com.
authors.forename: Zhenhui
authors.initials: Z
authors.lastname: Guo
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. Centre for Healthcare of the Elderly, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Rockwood
mesh_terms: D000369:Aged, 80 and over; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D010343:Patient Admission; D011446:Prospective Studies
keywords: Frailty; Frailty index; Older patients; Specialized geriatric intensive care unit; Survival