TY - JOUR
T1 - Routine Frailty Screening in Critical Illness
T2 - A Population-Based Cohort Study in Australia and New Zealand
AU - Darvall, Jai N.
AU - Bellomo, Rinaldo
AU - Paul, Eldho
AU - Bailey, Michael
AU - Young, Paul J.
AU - Reid, Alice
AU - Rockwood, Kenneth
AU - Pilcher, David
N1 - Funding Information:
Other contributions: The authors and the ANZICS CORE management committee thank clinicians, data collectors, and researchers at contributing sites ( e-Table 18 ). This research was conducted during the tenure of a Health Research Council of New Zealand Clinical Practitioner Fellowship held by P.J. Y. The Medical Research Institute of New Zealand is supported by Independent Research Organisation funding from the Health Research Council of New Zealand .
Funding Information:
Author contributions: J. N. D. and E. P. are the guarantors of the content of the manuscript, including the data and analysis. J. N. D. designed the study and carried out the literature search, data analysis, data interpretation, and writing and revision of the manuscript. R. B. D. P. P. J. Y. and K. R. designed the study and carried out study supervision, data analysis, data interpretation, and writing and revision of the manuscript. A. R. carried out data interpretation and writing and revision of the manuscript. E. P. and M. B. designed the study and carried out data analysis, data interpretation, and writing and revision of the manuscript. All authors had access to the study data and approved the final version of the manuscript. Financial/nonfinancial disclosures: The authors have reported to CHEST the following: K. R. reports personal speaking fees from Clinical Cardio Day-Cape Breton University; CRIUGM (Centre de recherche de l'Institut universitaire de G?riatrie de Montr?al); Jackson Lab, Bar Harbor, MA; MouseAge, Rome, Italy; the Frontemporal Dementia Study-Group; and SunLife Insurance, Japan, outside the submitted work. K. R. is the cofounder of Ardea Outcomes, which (as DGI Clinical) in the last 5 years has contracts with pharmaceutical companies and device manufacturers (Hollister, Nutricia, Novartis, Roche, Shire, and Takeda) on individualized outcome measurement. In 2017, he attended an advisory board meeting with Lundbeck. He is associate director of the Canadian Consortium on Neurodegeneration in Aging, which is funded by the Canadian Institutes of Health Research, and with additional funding from the Alzheimer Society of Canada and several other charities. He receives career support from the Dalhousie Medical Research Foundation as the Kathryn Allen Weldon Professor of Alzheimer Research and research support from the Canadian Institutes of Health Research, the QEII Health Science Centre Foundation, the Capital Health Research Fund, and the Fountain Family Innovation Fund of the QEII Health Science Centre Foundation. None declared (J. N. D. R. B. E. P. M. B. P. J. Y. A. R. D. P.). Other contributions: The authors and the ANZICS CORE management committee thank clinicians, data collectors, and researchers at contributing sites (e-Table 18). This research was conducted during the tenure of a Health Research Council of New Zealand Clinical Practitioner Fellowship held by P.J. Y. The Medical Research Institute of New Zealand is supported by Independent Research Organisation funding from the Health Research Council of New Zealand. Additional information: The e-Figures and e-Tables can be found in the Supplemental Materials section of the online article. FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.
Funding Information:
Financial/nonfinancial disclosures: The authors have reported to CHEST the following: K. R. reports personal speaking fees from Clinical Cardio Day-Cape Breton University; CRIUGM (Centre de recherche de l’Institut universitaire de Gériatrie de Montréal); Jackson Lab, Bar Harbor, MA; MouseAge, Rome, Italy; the Frontemporal Dementia Study-Group; and SunLife Insurance, Japan, outside the submitted work. K. R. is the cofounder of Ardea Outcomes, which (as DGI Clinical) in the last 5 years has contracts with pharmaceutical companies and device manufacturers (Hollister, Nutricia, Novartis, Roche, Shire, and Takeda) on individualized outcome measurement. In 2017, he attended an advisory board meeting with Lundbeck. He is associate director of the Canadian Consortium on Neurodegeneration in Aging, which is funded by the Canadian Institutes of Health Research , and with additional funding from the Alzheimer Society of Canada and several other charities. He receives career support from the Dalhousie Medical Research Foundation as the Kathryn Allen Weldon Professor of Alzheimer Research and research support from the Canadian Institutes of Health Research , the QEII Health Science Centre Foundation, the Capital Health Research Fund, and the Fountain Family Innovation Fund of the QEII Health Science Centre Foundation. None declared (J. N. D., R. B., E. P., M. B., P. J. Y., A. R., D. P.).
Publisher Copyright:
© 2021 American College of Chest Physicians
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/10
Y1 - 2021/10
N2 - Background: Frailty is associated with poor outcomes in critical illness. However, it is unclear whether frailty screening on admission to the ICU can be conducted routinely at the population level and whether it has prognostic importance. Research Question: Can population-scale frailty screening with the Clinical Frailty Scale (CFS) be implemented for critically ill adults in Australia and New Zealand (ANZ) and can it identify patients at risk of negative outcomes? Study Design and Methods: We conducted a binational prospective cohort study of critically ill adult patients admitted between July 1, 2018, and June 30, 2020, in 175 ICUs in ANZ. We classified frailty with the CFS on admission to the ICU. The primary outcome was in-hospital mortality; secondary outcomes were length of stay (LOS), discharge destination, complications (delirium, pressure injury), and duration of survival. Results: We included 234,568 critically ill patients; 45,245 (19%) were diagnosed as living with frailty before ICU admission. Patients with vs without frailty had higher in-hospital mortality (16% vs 5%; P < .001), delirium (10% vs 4%; P < .001), longer LOS in the ICU and hospital, and increased new chronic care discharge (3% vs 1%; P < .001), with worse outcomes associated with increasing CFS category. Of patients with very severe frailty (CFS score, 8), 39% died in hospital vs 2% of very fit patients (CFS score, 1; multivariate categorical CFS score, 8 [reference, 1]; OR, 7.83 [95% CI, 6.39–9.59]; P < .001). After adjustment for illness severity, frailty remained highly significantly predictive of mortality, including among patients younger than 50 years, with improvement in the area under the receiver operating characteristic curve of the Acute Physiology and Chronic Health Evaluation III-j score to 0.882 (95% CI, 0.879–0.885) from 0.868 (95% CI, 0.866–0.871) with the addition of frailty (P < .001). Interpretation: Large-scale population screening for frailty degree in critical illness was possible and prognostically important, with greater frailty (especially CFS score of ≥ 6) associated with worse outcomes, including among younger patients.
AB - Background: Frailty is associated with poor outcomes in critical illness. However, it is unclear whether frailty screening on admission to the ICU can be conducted routinely at the population level and whether it has prognostic importance. Research Question: Can population-scale frailty screening with the Clinical Frailty Scale (CFS) be implemented for critically ill adults in Australia and New Zealand (ANZ) and can it identify patients at risk of negative outcomes? Study Design and Methods: We conducted a binational prospective cohort study of critically ill adult patients admitted between July 1, 2018, and June 30, 2020, in 175 ICUs in ANZ. We classified frailty with the CFS on admission to the ICU. The primary outcome was in-hospital mortality; secondary outcomes were length of stay (LOS), discharge destination, complications (delirium, pressure injury), and duration of survival. Results: We included 234,568 critically ill patients; 45,245 (19%) were diagnosed as living with frailty before ICU admission. Patients with vs without frailty had higher in-hospital mortality (16% vs 5%; P < .001), delirium (10% vs 4%; P < .001), longer LOS in the ICU and hospital, and increased new chronic care discharge (3% vs 1%; P < .001), with worse outcomes associated with increasing CFS category. Of patients with very severe frailty (CFS score, 8), 39% died in hospital vs 2% of very fit patients (CFS score, 1; multivariate categorical CFS score, 8 [reference, 1]; OR, 7.83 [95% CI, 6.39–9.59]; P < .001). After adjustment for illness severity, frailty remained highly significantly predictive of mortality, including among patients younger than 50 years, with improvement in the area under the receiver operating characteristic curve of the Acute Physiology and Chronic Health Evaluation III-j score to 0.882 (95% CI, 0.879–0.885) from 0.868 (95% CI, 0.866–0.871) with the addition of frailty (P < .001). Interpretation: Large-scale population screening for frailty degree in critical illness was possible and prognostically important, with greater frailty (especially CFS score of ≥ 6) associated with worse outcomes, including among younger patients.
KW - delirium
KW - frailty
KW - ICU
KW - mortality
KW - risk prediction
UR - http://www.scopus.com/inward/record.url?scp=85114232888&partnerID=8YFLogxK
U2 - 10.1016/j.chest.2021.05.049
DO - 10.1016/j.chest.2021.05.049
M3 - Article
C2 - 34089741
AN - SCOPUS:85114232888
SN - 0012-3692
VL - 160
SP - 1292
EP - 1303
JO - Chest
JF - Chest
IS - 4
ER -