TY - JOUR
T1 - The Clinical Frailty Scale for mortality prediction of old acutely admitted intensive care patients
T2 - a meta-analysis of individual patient-level data
AU - Bruno, Raphael Romano
AU - Wernly, Bernhard
AU - Bagshaw, Sean M.
AU - van den Boogaard, Mark
AU - Darvall, Jai N.
AU - De Geer, Lina
AU - de Gopegui Miguelena, Pablo Ruiz
AU - Heyland, Daren K.
AU - Hewitt, David
AU - Hope, Aluko A.
AU - Langlais, Emilie
AU - Le Maguet, Pascale
AU - Montgomery, Carmel L.
AU - Papageorgiou, Dimitrios
AU - Seguin, Philippe
AU - Geense, Wytske W.
AU - Silva-Obregón, J. Alberto
AU - Wolff, Georg
AU - Polzin, Amin
AU - Dannenberg, Lisa
AU - Kelm, Malte
AU - Flaatten, Hans
AU - Beil, Michael
AU - Franz, Marcus
AU - Sviri, Sigal
AU - Leaver, Susannah
AU - Guidet, Bertrand
AU - Boumendil, Ariane
AU - Jung, Christian
N1 - Publisher Copyright:
© 2023, The Author(s).
PY - 2023/12
Y1 - 2023/12
N2 - Background: This large-scale analysis pools individual data about the Clinical Frailty Scale (CFS) to predict outcome in the intensive care unit (ICU). Methods: A systematic search identified all clinical trials that used the CFS in the ICU (PubMed searched until 24th June 2020). All patients who were electively admitted were excluded. The primary outcome was ICU mortality. Regression models were estimated on the complete data set, and for missing data, multiple imputations were utilised. Cox models were adjusted for age, sex, and illness acuity score (SOFA, SAPS II or APACHE II). Results: 12 studies from 30 countries with anonymised individualised patient data were included (n = 23,989 patients). In the univariate analysis for all patients, being frail (CFS ≥ 5) was associated with an increased risk of ICU mortality, but not after adjustment. In older patients (≥ 65 years) there was an independent association with ICU mortality both in the complete case analysis (HR 1.34 (95% CI 1.25–1.44), p < 0.0001) and in the multiple imputation analysis (HR 1.35 (95% CI 1.26–1.45), p < 0.0001, adjusted for SOFA). In older patients, being vulnerable (CFS 4) alone did not significantly differ from being frail. After adjustment, a CFS of 4–5, 6, and ≥ 7 was associated with a significantly worse outcome compared to CFS of 1–3. Conclusions: Being frail is associated with a significantly increased risk for ICU mortality in older patients, while being vulnerable alone did not significantly differ. New Frailty categories might reflect its “continuum” better and predict ICU outcome more accurately. Trial registration: Open Science Framework (OSF: https://osf.io/8buwk/). Graphical Abstract: [Figure not available: see fulltext.]
AB - Background: This large-scale analysis pools individual data about the Clinical Frailty Scale (CFS) to predict outcome in the intensive care unit (ICU). Methods: A systematic search identified all clinical trials that used the CFS in the ICU (PubMed searched until 24th June 2020). All patients who were electively admitted were excluded. The primary outcome was ICU mortality. Regression models were estimated on the complete data set, and for missing data, multiple imputations were utilised. Cox models were adjusted for age, sex, and illness acuity score (SOFA, SAPS II or APACHE II). Results: 12 studies from 30 countries with anonymised individualised patient data were included (n = 23,989 patients). In the univariate analysis for all patients, being frail (CFS ≥ 5) was associated with an increased risk of ICU mortality, but not after adjustment. In older patients (≥ 65 years) there was an independent association with ICU mortality both in the complete case analysis (HR 1.34 (95% CI 1.25–1.44), p < 0.0001) and in the multiple imputation analysis (HR 1.35 (95% CI 1.26–1.45), p < 0.0001, adjusted for SOFA). In older patients, being vulnerable (CFS 4) alone did not significantly differ from being frail. After adjustment, a CFS of 4–5, 6, and ≥ 7 was associated with a significantly worse outcome compared to CFS of 1–3. Conclusions: Being frail is associated with a significantly increased risk for ICU mortality in older patients, while being vulnerable alone did not significantly differ. New Frailty categories might reflect its “continuum” better and predict ICU outcome more accurately. Trial registration: Open Science Framework (OSF: https://osf.io/8buwk/). Graphical Abstract: [Figure not available: see fulltext.]
KW - Elderly
KW - Frailty
KW - Individual patient-level data meta-analysis
KW - Intensive care medicine
KW - Outcome prediction
KW - Systematic review
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U2 - 10.1186/s13613-023-01132-x
DO - 10.1186/s13613-023-01132-x
M3 - Article
AN - SCOPUS:85159938951
SN - 2110-5820
VL - 13
JO - Annals of Intensive Care
JF - Annals of Intensive Care
IS - 1
M1 - 37
ER -