Frailty increases the mortality risk by two-fold in middle-aged ICU patients.

Sweden: A new study found that premorbid frailty is independently associated with mortality, and it increased the mortality risk by two-fold in middle-aged patients. It is commonly seen in nearly 55% of all ICU patients under 64 years. The study results were published in the journal Annals of Intensive care.  

Frailty assessment is a multidimensional syndrome indicating an increased vulnerability to stressors and has been extensively used recently in geriatrics in Intensive care units. Previous studies have shown that frailty increases negative outcomes and increases the risk of mortality in old-age intensive care patients. But its effect in younger populations is uncertain. Hence Lina De Geer et al from Linköping University, Linköping, Sweden conducted a prospective observational study in a tertiary-level mixed ICU to assess the impact of frailty on long-term survival in intensive care patients of different ages. 

From nearly 817 adult ICU patients, data were collected on various factors like premorbid frailty using the Clinical Frailty Score (CFS), the severity of illness using the Simplified Acute Physiology Score, (third version; SAPS3), limitations of care and outcome. Within 6 months (180 days) after ICU admission Hazard ratios (HR) for death were calculated. The association of frailty with outcome in different age groups was evaluated using the unadjusted and adjusted analyses. 

Key findings of the study: 

• Patients were classified into predefined age groups of 18–49 years (n = 241), 50–64 (n = 188), 65–79 (n = 311), and 80 years or older (n = 77)).
• The overall proportion of frail (CFS ≥ 5) patients was 41% (n = 333) in the total participants and frail increased with each age stratum. 
• There were more treatment restrictions, higher SAPS3, and higher ICU mortality among frail patients. 
• An increased risk of 180-day mortality was observed in all age groups with Frailty. 
• After adjustment for SAPS3, comorbidity, and limitations of treatment, the effect was significant only in patients aged 50–64 years. 

Thus, frailty can be used as a tool for assessing the mortality risk in younger ICU patients. 

Further reading: De Geer, L., Fredrikson, M. & Chew, M.S. Frailty is a stronger predictor of death in younger intensive care patients than in older patients: a prospective observational study. Ann. Intensive Care 12, 120 (2022). https://doi.org/10.1186/s13613-022-01098-2