The impacto frailty on mortality in older patients admitted to an Intensive Care Unit / El impacto de la fragilidad sobre la mortalidad de los pacientes ancianos ingresados en la unidad de cuidados intensivos

ABSTRACT

Objective: Frailty is a relatively new concept for intensivists, and is defined as a status of increased vulnerability to stressors associated with reduced reserve and function of different physiological systems. Supporting the hypothesis that frailty may be an important predictor of poor prognosis among older patients admitted to Intensive Care Unit (ICU), this study seeks to evaluate the association between frailty at ICU admission and short and long-term mortality.DesignAn unmatched case-control study was carried out.SettingIntensive Care Unit.Patients or participantsPatients≥80 years of age admitted to the ICU for medical reasons.InterventionsNone.Main variables of interestThe primary outcome was 30-day mortality, while secondary outcomes were ICU mortality and mortality at one year.ResultsMost of the patients were classified as frail at ICU admission (55.3%). The prevalence of frailty was higher among those who died than in those who were alive within 30 days from ICU admission (62.3% vs 48.3%, p=0.01). One-year mortality was higher in frail (84.4%) than in non-frail patients (65.2%, p<0.001). In the logistic regression analysis, after adjusting for potential confounders such as chronic diseases, clinical complexity, cause of ICU admission and use of advanced procedures, frailty was seen to be significantly associated to one-year mortality, but not with ICU mortality or 30-day mortality.DiscussionThe admission of geriatric patients to the ICU is increasing. Frailty assessment may play an important role in the clinical evaluation of such individuals for triage, but should not be considered a priori as an exclusion criterion for admission (AU)

RESUMEN

Objetivo: «Fragilidad» es un concepto relativamente nuevo para los intensivistas, y se define como un estado de mayor vulnerabilidad frente a los estresores asociados con una reducción de las reservas y del funcionamiento de distintos sistemas fisiológicos. Basándose en la hipótesis de que la fragilidad podría ser un importante factor predictivo de un mal pronóstico en pacientes ancianos ingresados en la unidad de cuidados intensivos (UCI), este estudio tenía por objeto evaluar la asociación entre la fragilidad en el momento del ingreso en la UCI y la mortalidad a corto y largo plazo.DiseñoEstudio de casos y controles sin emparejamiento.ÁmbitoUnidad de cuidados intensivos.Pacientes o participantesPacientes ≥80 años ingresados en la UCI por motivos médicos.IntervencionesNinguna.Variables de interés principalesLa variable principal fue la mortalidad a 30 días, mientras que las variables secundarias fueron la mortalidad en la UCI y al cabo de un año.ResultadosLa mayoría de los pacientes se clasificaron como frágiles en el momento de su ingreso en la UCI (55,3%). La prevalencia de la fragilidad fue más alta entre quienes fallecieron... (AU)