TY - JOUR
T1 - The contribution of frailty, cognition, activity of daily life and comorbidities on outcome in acutely admitted patients over 80 years in European ICUs
T2 - the VIP2 study
AU - the VIP2 study group
AU - Guidet, Bertrand
AU - de Lange, Dylan W.
AU - Boumendil, Ariane
AU - Leaver, Susannah
AU - Watson, Ximena
AU - Boulanger, Carol
AU - Szczeklik, Wojciech
AU - Artigas, Antonio
AU - Morandi, Alessandro
AU - Andersen, Finn
AU - Zafeiridis, Tilemachos
AU - Jung, Christian
AU - Moreno, Rui
AU - Walther, Sten
AU - Oeyen, Sandra
AU - Schefold, Joerg C.
AU - Cecconi, Maurizio
AU - Marsh, Brian
AU - Joannidis, Michael
AU - Nalapko, Yuriy
AU - Elhadi, Muhammed
AU - Fjølner, Jesper
AU - Flaatten, Hans
AU - Eller, Philipp
AU - Helbok, Raimund
AU - Schmutz, René
AU - Nollet, Joke
AU - de Neve, Nikolaas
AU - De Buysscher, Pieter
AU - Swinnen, Walter
AU - Mikačić, Marijana
AU - Bastiansen, Anders
AU - Husted, Andreas
AU - Dahle, Bård E.S.
AU - Cramer, Christine
AU - Sølling, Christoffer
AU - Ørsnes, Dorthe
AU - Thomsen, Jakob Edelberg
AU - Pedersen, Jonas Juul
AU - Enevoldsen, Mathilde Hummelmose
AU - Elkmann, Thomas
AU - Kubisz-Pudelko, Agnieszka
AU - Pope, Alan
AU - Collins, Amy
AU - Raj, Ashok S.
AU - Boulanger, Carole
AU - Frey, Christian
AU - Hart, Ciaran
AU - Bolger, Clare
AU - Cilloniz, Catia
N1 - Publisher Copyright:
© 2019, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2020/1/1
Y1 - 2020/1/1
N2 - Purpose: Premorbid conditions affect prognosis of acutely-ill aged patients. Several lines of evidence suggest geriatric syndromes need to be assessed but little is known on their relative effect on the 30-day survival after ICU admission. The primary aim of this study was to describe the prevalence of frailty, cognition decline and activity of daily life in addition to the presence of comorbidity and polypharmacy and to assess their influence on 30-day survival. Methods: Prospective cohort study with 242 ICUs from 22 countries. Patients 80 years or above acutely admitted over a six months period to an ICU between May 2018 and May 2019 were included. In addition to common patients’ characteristics and disease severity, we collected information on specific geriatric syndromes as potential predictive factors for 30-day survival, frailty (Clinical Frailty scale) with a CFS > 4 defining frail patients, cognitive impairment (informant questionnaire on cognitive decline in the elderly (IQCODE) with IQCODE ≥ 3.5 defining cognitive decline, and disability (measured the activity of daily life with the Katz index) with ADL ≤ 4 defining disability. A Principal Component Analysis to identify co-linearity between geriatric syndromes was performed and from this a multivariable model was built with all geriatric information or only one: CFS, IQCODE or ADL. Akaike’s information criterion across imputations was used to evaluate the goodness of fit of our models. Results: We included 3920 patients with a median age of 84 years (IQR: 81–87), 53.3% males). 80% received at least one organ support. The median ICU length of stay was 3.88 days (IQR: 1.83–8). The ICU and 30-day survival were 72.5% and 61.2% respectively. The geriatric conditions were median (IQR): CFS: 4 (3–6); IQCODE: 3.19 (3–3.69); ADL: 6 (4–6); Comorbidity and Polypharmacy score (CPS): 10 (7–14). CFS, ADL and IQCODE were closely correlated. The multivariable analysis identified predictors of 1-month mortality (HR; 95% CI): Age (per 1 year increase): 1.02 (1.–1.03, p = 0.01), ICU admission diagnosis, sequential organ failure assessment score (SOFA) (per point): 1.15 (1.14–1.17, p < 0.0001) and CFS (per point): 1.1 (1.05–1.15, p < 0.001). CFS remained an independent factor after inclusion of life-sustaining treatment limitation in the model. Conclusion: We confirm that frailty assessment using the CFS is able to predict short-term mortality in elderly patients admitted to ICU. Other geriatric syndromes do not add improvement to the prediction model. Since CFS is easy to measure, it should be routinely collected for all elderly ICU patients in particular in connection to advance care plans, and should be used in decision making.
AB - Purpose: Premorbid conditions affect prognosis of acutely-ill aged patients. Several lines of evidence suggest geriatric syndromes need to be assessed but little is known on their relative effect on the 30-day survival after ICU admission. The primary aim of this study was to describe the prevalence of frailty, cognition decline and activity of daily life in addition to the presence of comorbidity and polypharmacy and to assess their influence on 30-day survival. Methods: Prospective cohort study with 242 ICUs from 22 countries. Patients 80 years or above acutely admitted over a six months period to an ICU between May 2018 and May 2019 were included. In addition to common patients’ characteristics and disease severity, we collected information on specific geriatric syndromes as potential predictive factors for 30-day survival, frailty (Clinical Frailty scale) with a CFS > 4 defining frail patients, cognitive impairment (informant questionnaire on cognitive decline in the elderly (IQCODE) with IQCODE ≥ 3.5 defining cognitive decline, and disability (measured the activity of daily life with the Katz index) with ADL ≤ 4 defining disability. A Principal Component Analysis to identify co-linearity between geriatric syndromes was performed and from this a multivariable model was built with all geriatric information or only one: CFS, IQCODE or ADL. Akaike’s information criterion across imputations was used to evaluate the goodness of fit of our models. Results: We included 3920 patients with a median age of 84 years (IQR: 81–87), 53.3% males). 80% received at least one organ support. The median ICU length of stay was 3.88 days (IQR: 1.83–8). The ICU and 30-day survival were 72.5% and 61.2% respectively. The geriatric conditions were median (IQR): CFS: 4 (3–6); IQCODE: 3.19 (3–3.69); ADL: 6 (4–6); Comorbidity and Polypharmacy score (CPS): 10 (7–14). CFS, ADL and IQCODE were closely correlated. The multivariable analysis identified predictors of 1-month mortality (HR; 95% CI): Age (per 1 year increase): 1.02 (1.–1.03, p = 0.01), ICU admission diagnosis, sequential organ failure assessment score (SOFA) (per point): 1.15 (1.14–1.17, p < 0.0001) and CFS (per point): 1.1 (1.05–1.15, p < 0.001). CFS remained an independent factor after inclusion of life-sustaining treatment limitation in the model. Conclusion: We confirm that frailty assessment using the CFS is able to predict short-term mortality in elderly patients admitted to ICU. Other geriatric syndromes do not add improvement to the prediction model. Since CFS is easy to measure, it should be routinely collected for all elderly ICU patients in particular in connection to advance care plans, and should be used in decision making.
KW - Activities of daily living
KW - Cognitive functioning
KW - Comorbidity
KW - Critical care
KW - Elderly
KW - Frailty
KW - Outcome
KW - Prediction
UR - http://www.scopus.com/inward/record.url?scp=85075888743&partnerID=8YFLogxK
U2 - 10.1007/s00134-019-05853-1
DO - 10.1007/s00134-019-05853-1
M3 - Original Article
C2 - 31784798
AN - SCOPUS:85075888743
SN - 0342-4642
VL - 46
SP - 57
EP - 69
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 1
ER -