A prospective multicenter cohort study of frailty in younger critically ill patients.
Frailty is a multidimensional syndrome characterized by loss of physiologic and cognitive reserve that heightens vulnerability. Frailty has been well described among elderly patients (i.e., 65 years of age or older), but few studies have evaluated frailty in nonelderly patients with critical illness. We aimed to describe the prevalence, correlates, and outcomes associated with frailty among younger critically ill patients.



We conducted a prospective cohort study of 197 consecutive critically ill patients aged 50-64.9 years admitted to intensive care units (ICUs) at six hospitals across Alberta, Canada. Frailty was defined as a score ≥5 on the Clinical Frailty Scale before hospitalization. Multivariable analyses were used to evaluate factors independently associated with frailty before ICU admission and the independent association between frailty and outcome.



In the 197 patients in the study, mean (SD) age was 58.5 (4.1) years, 37 % were female, 73 % had three or more comorbid illnesses, and 28 % (n = 55; 95 % CI 22-35) were frail. Factors independently associated with frailty included not being completely independent (adjusted OR [aOR] 4.4, 95 % CI 1.8-11.1), connective tissue disease (aOR 6.0, 95 % CI 2.1-17.0), and hospitalization within the preceding year (aOR 3.3, 95 % CI 1.3-8.1). There were no significant differences between frail and nonfrail patients in reason for admission, Acute Physiology and Chronic Health Evaluation II score, preference for life support, or treatment intensity. Younger frail patients did not have significantly longer (median [interquartile range]) hospital stay (26 [9-68] days vs. 19 [10-43] days; p = 0.4), but they had greater 1-year rehospitalization rates (61 % vs. 40 %; p = 0.02) and higher 1-year mortality (33 % vs. 20 %; adjusted HR 1.8, 95 % CI 1.0-3.3; p = 0.039).



Prehospital frailty is common among younger critically ill patients, and in this study it was associated with higher rates of mortality at 1 year and with rehospitalization. Our data suggest that frailty should be considered in younger adults admitted to the ICU, not just in the elderly. Additional research is needed to further characterize frailty in younger critically ill patients, along with the ideal instruments for identification.
Division of Critical Care Medicine (University of Alberta Hospital), Faculty of Medicine and Dentistry, University of Alberta, 2-124 Clinical Sciences Building, 8440-112 Street NW, Edmonton, AB, T6G 2B7, Canada. bagshaw@ualberta.ca.
M
M
Bagshaw
Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 5-112 Clinical Sciences Building, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada.
Sumit R
SR
Majumdar
Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 13-103 Clinical Sciences Building, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada.
Darryl B
DB
Rolfson
Population Health Research Institute, McMaster University, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada.
Quazi
Q
Ibrahim
Department of Medicine, Faculty of Medicine and Dentistry, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.
Robert C
RC
McDermid
Department of Critical Care Medicine, Faculty of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.
H Tom
HT
Stelfox
D000369:Aged, 80 and over; D000416:Alberta / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D003240:Connective Tissue Diseases / Q000150:complications / Q000453:epidemiology; D016638:Critical Illness / Q000145:classification* / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D016330:Frail Elderly; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000295:instrumentation; D008875:Middle Aged; D063868:Patient Outcome Assessment; D011446:Prospective Studies; D016019:Survival Analysis
Critical illness; Frailty; Health services; Intensive care unit; Mortality; Quality of life