Abstract
BackgroundIn intensive care units (ICU) octogenarians become a routine patients group with aggravated therapeutic and diagnostic decision-making. Due to increased mortality and a reduced quality of life in this high-risk population, medical decision-making a fortiori requires an optimum of risk stratification. Recently, the VIP-1 trial prospectively observed that the clinical frailty scale (CFS) performed well in ICU patients in overall-survival and short-term outcome prediction. However, it is known that healthcare systems differ in the 21 countries contributing to the VIP-1 trial. Hence, our main focus was to investigate whether the CFS is usable for risk stratification in octogenarians admitted to diversified and high tech German ICUs.MethodsThis multicentre prospective cohort study analyses very old patients admitted to 20 German ICUs as a sub-analysis of the VIP-1 trial. Three hundred and eight patients of 80 years of age or older admitted consecutively to participating ICUs. CFS, cause of admission, APACHE II, SAPS II and SOFA scores, use of ICU resources and ICU- and 30-day mortality were recorded. Multivariate logistic regression analysis was used to identify factors associated with 30-day mortality.ResultsPatients had a median age of 84 [IQR 82–87] years and a mean CFS of 4.75 (± 1.6 standard-deviation) points. More than half of the patients (53.6%) were classified as frail (CFS ≥ 5). ICU-mortality was 17.3% and 30-day mortality was 31.2%. The cause of admission (planned vs. unplanned), (OR 5.74) and the CFS (OR 1.44 per point increase) were independent predictors of 30-day survival.ConclusionsThe CFS is an easy determinable valuable tool for prediction of 30-day ICU survival in octogenarians, thus, it may facilitate decision-making for intensive care givers in Germany.Trial registrationThe VIP-1 study was retrospectively registered on ClinicalTrials.gov (ID: NCT03134807) on May 1, 2017.
Highlights
In intensive care units (ICU) octogenarians become a routine patients group with aggravated therapeutic and diagnostic decision-making
The prospective, observational, European-ICU-network based VIP-1 study demonstrated that frailty is a significant factor reducing 30-day survival and that the 9-point Clinical Frailty Scale (CFS) is an appropriate tool to assess this effect [4]
The VIP-1 study was coordinated by the Health Services Resource and Outcome (HSRO) section of the European Society of Intensive Care Medicine (ESICM) and was registered on ClinicalTrials.gov (ID: NCT03134807; first posted on May 1st 2017 after recruitment completed)
Summary
In intensive care units (ICU) octogenarians become a routine patients group with aggravated therapeutic and diagnostic decision-making. The VIP-1 trial prospectively observed that the clinical frailty scale (CFS) performed well in ICU patients in overall-survival and short-term outcome prediction. More scientific and clinical interest must be applied on all aspects of geriatric medicine to adapt existing risk-stratification data to daily clinical scenarios [5, 6]. In this context, a 9-point Clinical Frailty Scale (CFS) as an advancement of the Canadian 7-point CFS has been developed [7]. Whereas physical frailty is a measurable clinical phenotype of increased vulnerability for developing adverse outcomes (e.g. disability and/or mortality) when exposed to a stressor, it is highly difficult to explain the current frailty status in an abbreviated and objective manner to another medical-professional
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