title: Is frailty a prognostic factor for critically ill elderly patients?
abstract: OBJECTIVE
  The study aimed to investigate the effects of frailty on clinical outcomes of patients in an intensive care unit (ICU).
  
  
  METHODS
  In this prospective study, 122 patients (59 frail, 37 pre-frail and 26 robust) were included. A frailty index (FI) derived from comprehensive geriatric assessment parameters was used for the evaluation. The FI score of ≤0.25 was considered as robust, 0.25-0.40 as pre-frail and >0.40 as frail. The prognostic effects of FI were investigated and FI and APACHE II and SOFA scores, the prognostic scores using in ICU, were compared.
  
  
  RESULTS
  Median age of the patients was 71 years old and 50.8 % were male. ICU mortality rate and median length of stay (LOS) were 51.6 % and 8 days (min-max: 1-148), respectively. ICU mortality was higher (69.2, 56.8 and 40.7 %, respectively, p = 0.040) and median overall survival was lower in frail group compared to pre-frail and robust subjects (23, 31 and 140 days, p = 0.013, respectively). Long term mortality over 3 and 6 months in frail patients were 80.8 and 84.6 %, respectively and significantly higher than others. Multivariate analysis showed that LOS in ICU (HR 1.067, 95 % CI 1.021-1.114), SOFA score (HR 1.272, 95 % CI 1.096-1.476) and FI (HR 39.019, 95 % CI 1.235-1232.537) were the independent correlates for ICU mortality (p = 0.004, p = 0.002 and 0.038, respectively). There was a weak but statistically significant positive correlation between APACHE II and FI scores (r = 0.190, p = 0.036).
  
  
  CONCLUSIONS
  FI may be used as a predictor for the evaluation of elderly patients' clinical outcomes in ICUs.
authors.affiliation: Department of Internal Medicine, Division of Geriatrics, Gazi University School of Medicine, 06560, Besevler, Ankara, Turkey. drcemalk@yahoo.com.tr.
authors.forename: Muhammet Cemal
authors.initials: MC
authors.lastname: Kizilarslanoglu
authors.affiliation: Department of Internal Medicine, Division of Geriatrics, Gazi University School of Medicine, 06560, Besevler, Ankara, Turkey.
authors.forename: Ramazan
authors.initials: R
authors.lastname: Civelek
authors.affiliation: Department of Internal Medicine, Division of Geriatrics, Gazi University School of Medicine, 06560, Besevler, Ankara, Turkey.
authors.forename: Mustafa Kemal
authors.initials: MK
authors.lastname: Kilic
authors.affiliation: Department of Internal Medicine, Division of Geriatrics, Gazi University School of Medicine, 06560, Besevler, Ankara, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Sumer
authors.affiliation: Department of Internal Medicine, Division of Geriatrics, Gazi University School of Medicine, 06560, Besevler, Ankara, Turkey.
authors.forename: Hacer Dogan
authors.initials: HD
authors.lastname: Varan
authors.affiliation: Department of Internal Medicine, Division of Geriatrics, Gazi University School of Medicine, 06560, Besevler, Ankara, Turkey.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Kara
authors.affiliation: Department of Internal Medicine, Division of Geriatrics, Gazi University School of Medicine, 06560, Besevler, Ankara, Turkey.
authors.forename: Gunes
authors.initials: G
authors.lastname: Arik
authors.affiliation: Department of Internal Medicine, Division of Intensive Care, Gazi University School of Medicine, Ankara, Turkey.
authors.forename: Melda
authors.initials: M
authors.lastname: Turkoglu
authors.affiliation: Department of Internal Medicine, Division of Intensive Care, Gazi University School of Medicine, Ankara, Turkey.
authors.forename: Gulbin
authors.initials: G
authors.lastname: Aygencel
authors.affiliation: Department of Internal Medicine, Division of Geriatrics, Gazi University School of Medicine, 06560, Besevler, Ankara, Turkey.
authors.forename: Zekeriya
authors.initials: Z
authors.lastname: Ulger
mesh_terms: D018806:APACHE; D000368:Aged; D016638:Critical Illness / Q000453:epidemiology*; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009026:Mortality; D011379:Prognosis; D011446:Prospective Studies; D012107:Research Design; D013223:Statistics as Topic; D014421:Turkey / Q000453:epidemiology
keywords: APACHE II; Elderly; Frailty; Intensive care unit; SOFA score