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Mortality in Relation to Frailty in Patients Admitted to a Specialized Geriatric Intensive Care Unit

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...

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Autores principales: Zeng, An, Song, Xiaowei, Dong, Jiahui, Mitnitski, Arnold, Liu, Jian, Guo, Zhenhui, Rockwood, Kenneth
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4631107/
https://www.ncbi.nlm.nih.gov/pubmed/26400736
http://dx.doi.org/10.1093/gerona/glv084
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author Zeng, An
Song, Xiaowei
Dong, Jiahui
Mitnitski, Arnold
Liu, Jian
Guo, Zhenhui
Rockwood, Kenneth
author_facet Zeng, An
Song, Xiaowei
Dong, Jiahui
Mitnitski, Arnold
Liu, Jian
Guo, Zhenhui
Rockwood, Kenneth
author_sort Zeng, An
collection PubMed
description 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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spelling pubmed-46311072015-11-12 Mortality in Relation to Frailty in Patients Admitted to a Specialized Geriatric Intensive Care Unit Zeng, An Song, Xiaowei Dong, Jiahui Mitnitski, Arnold Liu, Jian Guo, Zhenhui Rockwood, Kenneth J Gerontol A Biol Sci Med Sci Research Article 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. Oxford University Press 2015-12 2015-09-22 /pmc/articles/PMC4631107/ /pubmed/26400736 http://dx.doi.org/10.1093/gerona/glv084 Text en © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. http://creativecommons.org/licenses/by-nc-nd/3.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Research Article
Zeng, An
Song, Xiaowei
Dong, Jiahui
Mitnitski, Arnold
Liu, Jian
Guo, Zhenhui
Rockwood, Kenneth
Mortality in Relation to Frailty in Patients Admitted to a Specialized Geriatric Intensive Care Unit
title Mortality in Relation to Frailty in Patients Admitted to a Specialized Geriatric Intensive Care Unit
title_full Mortality in Relation to Frailty in Patients Admitted to a Specialized Geriatric Intensive Care Unit
title_fullStr Mortality in Relation to Frailty in Patients Admitted to a Specialized Geriatric Intensive Care Unit
title_full_unstemmed Mortality in Relation to Frailty in Patients Admitted to a Specialized Geriatric Intensive Care Unit
title_short Mortality in Relation to Frailty in Patients Admitted to a Specialized Geriatric Intensive Care Unit
title_sort mortality in relation to frailty in patients admitted to a specialized geriatric intensive care unit
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4631107/
https://www.ncbi.nlm.nih.gov/pubmed/26400736
http://dx.doi.org/10.1093/gerona/glv084
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