Journal
JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES
Volume 70, Issue 12, Pages 1586-1594Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/gerona/glv084
Keywords
Frailty; Frailty index; Specialized geriatric intensive care unit; Older patients; Survival
Categories
Funding
- China-Canada Joint Health Research Initiative Grant from the Canadian Institutes of Health Research [CIHR CCI-92216]
- National Natural Science Foundation of China [E0603-59976016, 61300107]
- Chinese Military Medicine and Health Foundation [119-10BJZ09]
- Natural Science Foundation of Guangdong [S2012010010212]
- Science and Technology Planning Project of Guangdong, China [2012A061400010]
- Science and Technology Planning Project of Guangzhou, China [201505031501397, 201504301341059]
- Guangdong Key Laboratory of Geriatric Infection and Organ Function
- Fountain Innovation Fund of the Queen Elizabeth II Health Sciences Research Foundation, Halifax, Canada
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Background. In older adults admitted to intensive care units (ICUs), frailty influences prognosis. We examined the relationship between the frailty index (FI) based on deficit accumulation and early and late survival. Methods. Older patients (>= 65 years) admitted to a specialized geriatric ICU at the Liuhuaqiao Hospital, Guangzhou, China between July-December 2011 (n = 155; age 82.7 +/- 7.1 y; 87.1% men) were followed for 300 days. The FI was calculated as the proportion present of 52 health deficits. FI performance was compared with that of several prognostic scores. Results. The 90-day death rate was 38.7% (n = 60; 27 died within 30 days). The FI score was correlated with the Glasgow Coma Scale, Karnofsky Scale, Palliative Performance Scale, Acute Physiology Score-APACHE II and APACHE IV (r(2) = 0.52 to 0.72, p < 0.001). Patients who died within 30 days had higher mean FI scores (0.41 +/- 0.11) than those who survived to 300 days (0.22 +/- 0.11; F = 38.91, p < 0.001). Each 1% increase in the FI from the previous level was associated with an 11% increase in the 30-day mortality risk (95% CI: 7%-15%) adjusting for age, sex, and the prognostic scores. The FI discriminated patients who died in 30 days from those who survived with moderately high accuracy (AUC = 0.89 +/- 0.03). No one with an FI score >0.46 survived past 90 days. Conclusion. ICU survival was strongly associated with the level of frailty at admission. An FI based on health deficit accumulation may help improve critical care outcome prediction in older adults.
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