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Intensive Care Medicine

, Volume 43, Issue 8, pp 1105–1122

First Online: 04 July 2017Received: 30 March 2017Accepted: 14 June 2017

Abstract

PurposeFunctional status and chronic health status are important baseline characteristics of critically ill patients. The assessment of frailty on admission to the intensive care unit ICU may provide objective, prognostic information on baseline health. To determine the impact of frailty on the outcome of critically ill patients, we performed a systematic review and meta-analysis comparing clinical outcomes in frail and non-frail patients admitted to ICU.

MethodsWe searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PubMed, CINAHL, and Clinicaltrials.gov. All study designs with the exception of narrative reviews, case reports, and editorials were included. Included studies assessed frailty in patients greater than 18 years of age admitted to an ICU and compared outcomes between fit and frail patients. Two reviewers independently applied eligibility criteria, assessed quality, and extracted data. The primary outcomes were hospital and long-term mortality. We also determined the prevalence of frailty, the impact on other patient-centered outcomes such as discharge disposition, and health service utilization such as length of stay.

ResultsTen observational studies enrolling a total of 3030 patients 927 frail and 2103 fit patients were included. The overall quality of studies was moderate. Frailty was associated with higher hospital mortality relative risk RR 1.71; 95% CI 1.43, 2.05; p < 0.00001; I = 32% and long-term mortality RR 1.53; 95% CI 1.40, 1.68; p < 0.00001; I = 0%. The pooled prevalence of frailty was 30% 95% CI 29–32%. Frail patients were less likely to be discharged home than fit patients RR 0.59; 95% CI 0.49, 0.71; p < 0.00001; I = 12%.

ConclusionsFrailty is common in patients admitted to ICU and is associated with worsened outcomes. Identification of this previously unrecognized and vulnerable ICU population should act as the impetus for investigating and implementing appropriate care plans for critically ill frail patients. Registration: PROSPERO ID: CRD42016053910.

KeywordsFrailty Frail elderly Frailty index Clinical frailty scale Critically ill Systematic review Braden Waters is the co-lead author.

Take-home message: Frailty is an important baseline characteristic of patients who are critically ill. In this meta-analysis, we show that critically ill frail patients, compared to non-frail patients, are at increased risk of mortality, adverse outcomes, and are less likely to be discharged home.

Electronic supplementary materialThe online version of this article doi:10.1007-s00134-017-4867-0 contains supplementary material, which is available to authorized users.

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Author: John Muscedere - Braden Waters - Aditya Varambally - Sean M. Bagshaw - J. Gordon Boyd - David Maslove - Stephanie Sibley

Source: https://link.springer.com/article/10.1007/s00134-017-4867-0







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