Frailty is a stronger predictor of death in younger intensive care patients than in older patients: a prospective observational study

Background

While frailty is a known predictor of adverse outcomes in older patients, its effect in younger populations is unknown. This prospective observational study was conducted in a tertiary-level mixed ICU to assess the impact of frailty on long-term survival in intensive care patients of different ages

Methods

Data on premorbid frailty (Clinical Frailty Score; CFS), severity of illness (the Simplified Acute Physiology Score, third version; SAPS3), limitations of care and outcome were collected in 817 adult ICU patients. Hazard ratios (HR) for death within 180 days after ICU admission were calculated. Unadjusted and adjusted analyses were used to evaluate the association of frailty with outcome in different age groups

Results

Patients were classified into predefined age groups (18–49 years ( n  = 241), 50–64 ( n  = 188), 65–79 ( n  = 311) and 80 years or older ( n  = 77)). The proportion of frail (CFS ≥ 5) patients was 41% ( n  = 333) in the overall population and increased with each age strata ( n  = 46 (19%) vs. n  = 67 (36%) vs. n  = 174 (56%) vs. n  = 46 (60%), P  < 0.05). Frail patients had higher SAPS3, more treatment restrictions and higher ICU mortality. Frailty was associated with an increased risk of 180-day mortality in all age groups (HR 5.7 (95% CI 2.8–11.4), P  < 0.05; 8.0 (4.0–16.2), P  < 0.05; 4.1 (2.2–6.6), P  < 0.05; 2.4 (1.1–5.0), P  = 0.02). The effect remained significant after adjustment for SAPS3, comorbidity and limitations of treatment only in patients aged 50–64 (2.1 (1.1–3.1), P  < 0.05)

Conclusions

Premorbid frailty is common in ICU patients of all ages and was found in 55% of patients aged under 64 years. Frailty was independently associated with mortality only among middle-aged patients, where the risk of death was increased twofold. Our study supports the use of frailty assessment in identifying younger ICU patients at a higher risk of death. A considerable proportion of younger patients requiring intensive care are frail. Frailty increases the risk of death up to 6 months after intensive care. The most marked effect of frailty on the risk of death is in middle-aged patients.