Frailty and Subsequent Disability and Mortality among Patients with Critical Illness

Brummel, Nathan E.; Bell, Susan P.; Girard, Timothy D.; Pandharipande, Pratik P.; Jackson, James C.; Morandi, Alessandro; Thompson, Jennifer L.; Chandrasekhar, Rameela; Bernard, Gordon R.; Dittus, Robert S.; Gill, Thomas M.; Ely, E. Wesley
July 2017
American Journal of Respiratory & Critical Care Medicine;7/1/2017, Vol. 196 Issue 1, p64
Academic Journal
journal article
Rationale: The prevalence of frailty (diminished physiologic reserve) and its effect on outcomes for those aged 18 years and older with critical illness is unclear.Objectives: We hypothesized greater frailty would be associated with subsequent mortality, disability, and cognitive impairment, regardless of age.Methods: At enrollment, we measured frailty using the Clinical Frailty Scale (range, 1 [very fit] to 7 [severely frail]). At 3 and 12 months post-discharge, we assessed vital status, instrumental activities of daily living, basic activities of daily living, and cognition. We used multivariable regression to analyze associations between Clinical Frailty Scale scores and outcomes, adjusting for age, sex, education, comorbidities, baseline disability, baseline cognition, severity of illness, delirium, coma, sepsis, mechanical ventilation, and sedatives/opiates.Measurements and Main Results: We enrolled 1,040 patients who were a median (interquartile range) of 62 (53-72) years old and who had a median Clinical Frailty Scale score of 3 (3-5). Half of those with clinical frailty (i.e., Clinical Frailty Scale score ≥5) were younger than 65 years old. Greater Clinical Frailty Scale scores were independently associated with greater mortality (P = 0.01 at 3 mo and P < 0.001 at 12 mo) and with greater odds of disability in instrumental activities of daily living (P = 0.04 at 3 mo and P = 0.002 at 12 mo). Clinical Frailty Scale scores were not associated with disability in basic activities of daily living or with cognition.Conclusions: Frailty is common in critically ill adults aged 18 years and older and is independently associated with increased mortality and greater disability. Future studies should explore routine screening for clinical frailty in critically ill patients of all ages. Interventions to reduce mortality and disability among patients with heightened vulnerability should be developed and tested. Clinical trial registered with www.clinicaltrials.gov (NCT 00392795 and NCT 00400062).


Related Articles

  • Ability to walk 1/4 mile predicts subsequent disability, mortality, and health care costs. Hardy, Susan E.; Yihuang Kang; Studenski, Stephanie A.; Degenholtz, Howard B.; Kang, Yihuang // JGIM: Journal of General Internal Medicine;Feb2011, Vol. 26 Issue 2, p130 

    Background: Mobility, such as walking 1/4 mile, is a valuable but underutilized health indicator among older adults. For mobility to be successfully integrated into clinical practice and health policy, an easily assessed marker that predicts subsequent health outcomes is...

  • Risk factors for major injurious falls among the home-dwelling elderly by functional abilities. A prospective population-based study. Koski, Keijo; Luukinen, Heikki; Laippala, Pekka; Kivelä, Sirkka-Liisa; Koski, K; Luukinen, H; Laippala, P; Kivelä, S L // Gerontology;1998, Vol. 44 Issue 4, p232 

    Background: In order to identify the risk factors essential for preventing major injurious falls, the associations between injurious falls and certain factors were assessed among disabled and independent elderly, respectively, who had fallen during a 2-year period.Methods:...

  • Prospective, Randomized Study on the Efficacy and Safety of Local UV-Free Blue Light Treatment of Eczema. Keemss, Kim; Pfaff, Stephanie C.; Born, Matthias; Liebmann, Jörg; Merk, Hans F.; von Felbert, Verena // Dermatology (10188665);Sep2016, Vol. 232 Issue 4, p496 

    Background: Blue light was shown to reduce the activation of T cells and modulate cytokine release in vitro. Therefore, we investigated the efficacy of blue light in the treatment of eczema.Methods: A sample of 21 patients with mild to moderate eczema were locally...

  • Defining secondary progressive multiple sclerosis. Lorscheider, Johannes; Buzzard, Katherine; Jokubaitis, Vilija; Spelman, Tim; Havrdova, Eva; Horakova, Dana; Trojano, Maria; Izquierdo, Guillermo; Girard, Marc; Duquette, Pierre; Prat, Alexandre; Lugaresi, Alessandra; Grand'Maison, François; Grammond, Pierre; Hupperts, Raymond; Alroughani, Raed; Sola, Patrizia; Boz, Cavit; Pucci, Eugenio; Lechner-Scott, Jeanette // Brain: A Journal of Neurology;9/1/2016, Vol. 139 Issue 9, p2395 

    A number of studies have been conducted with the onset of secondary progressive multiple sclerosis as an inclusion criterion or an outcome of interest. However, a standardized objective definition of secondary progressive multiple sclerosis has been lacking. The aim of this work was to evaluate...

  • Walking Training and Functioning Among Elderly Persons With Stroke: Results of a Prospective Cohort Study. Karttunen, Auli H.; Kallinen, Mauri; Peurala, Sinikka H.; Häkkinen, Arja // PM & R: Journal of Injury, Function & Rehabilitation;Dec2015, Vol. 7 Issue 12, p1205 

    Objective: To determine if 65- to 85-year-old persons who had a stroke within the previous 3-36 months can improve functioning and quality of life during walking rehabilitation. Design: Prospective cohort study with 6-month follow-up. Setting: Three...

  • Comparative Analysis of the Host Response to Community-acquired and Hospital-acquired Pneumonia in Critically Ill Patients. van Vught, Lonneke A.; Scicluna, Brendon P.; Wiewel, Maryse A.; Hoogendijk, Arie J.; Klouwenberg, Peter M. C. Klein; Franitza, Marek; Toliat, Mohammad R.; Nürnberg, Peter; Cremer, Olaf L.; Horn, Janneke; Schultz, Marcus J.; Bonten, Marc M. J.; van der Poll, Tom; Klein Klouwenberg, Peter M C // American Journal of Respiratory & Critical Care Medicine;12/1/2016, Vol. 194 Issue 11, p1366 

    Rationale: Preclinical studies suggest that hospitalized patients are susceptible to infections caused by nosocomial respiratory pathogens at least in part because of immune suppression caused by the condition for which they were admitted.Objectives: We aimed to...

  • Evaluation of hepatic impairment on pharmacokinetics and safety of crizotinib in patients with advanced cancer. El-Khoueiry, Anthony B; Sarantopoulos, John; O'Bryant, Cindy L; Ciombor, Kristen K; Xu, Huiping; O'Gorman, Melissa; Chakrabarti, Jayeta; Usari, Tiziana; El-Rayes, Bassel F // Cancer Chemotherapy & Pharmacology;Apr2018, Vol. 81 Issue 4, p659 

    Purpose: This phase 1 study evaluated the effect of hepatic impairment on pharmacokinetics and safety of crizotinib in patients with advanced cancer.Methods: Patients were dosed according to hepatic function classified by modified National Cancer Institute Organ...

  • Outcomes in Adults With Acute Liver Failure Between 1998 and 2013: An Observational Cohort Study. Reuben, Adrian; Tillman, Holly; Fontana, Robert J.; Davern, Timothy; McGuire, Brendan; Stravitz, R. Todd; Durkalski, Valerie; Larson, Anne M.; Iris Liou; Fix, Oren; Schilsky, Michael; McCashland, Timothy; Hay, J. Eileen; Murray, Natalie; Shaikh, Obaid S.; Ganger, Daniel; Zaman, Atif; Han, Steven B.; Chung, Raymond T.; Smith, Alastair // Annals of Internal Medicine;6/7/2016, Vol. 164 Issue 11, p724 

    Background: Acute liver failure (ALF) is a rare syndrome of severe, rapid-onset hepatic dysfunction-without prior advanced liver disease-that is associated with high morbidity and mortality. Intensive care and liver transplantation provide support and rescue,...

  • Surgical management of hemorrhoids. Patient Care Committee of The Society for Surgery of the Alimentary Tract (SSAT) // Journal of Gastrointestinal Surgery;Mar2005, Vol. 9 Issue 3, p455 

    No abstract available.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics