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Article Dans Une Revue Annals of Intensive Care Année : 2023

The Clinical Frailty Scale for mortality prediction of old acutely admitted intensive care patients: a meta-analysis of individual patient-level data

Sean Bagshaw
  • Fonction : Auteur
Mark van den Boogaard
  • Fonction : Auteur
Jai Darvall
  • Fonction : Auteur
Lina de Geer
  • Fonction : Auteur
Daren Heyland
  • Fonction : Auteur
David Hewitt
  • Fonction : Auteur
Aluko Hope
  • Fonction : Auteur
Pascale Le Maguet
  • Fonction : Auteur
Carmel Montgomery
  • Fonction : Auteur
Dimitrios Papageorgiou
  • Fonction : Auteur
Philippe Seguin
  • Fonction : Auteur
Wytske Geense
  • Fonction : Auteur
J Alberto Silva-Obregón
  • Fonction : Auteur
Georg Wolff
  • Fonction : Auteur
Amin Polzin
  • Fonction : Auteur
Lisa Dannenberg
  • Fonction : Auteur
Malte Kelm
  • Fonction : Auteur
Hans Flaatten
  • Fonction : Auteur
Michael Beil
  • Fonction : Auteur
Marcus Franz
  • Fonction : Auteur
Sigal Sviri
  • Fonction : Auteur
Susannah Leaver
  • Fonction : Auteur
Ariane Boumendil
  • Fonction : Auteur

Résumé

Abstract Background This large-scale analysis pools individual data about the Clinical Frailty Scale (CFS) to predict outcome in the intensive care unit (ICU). Methods A systematic search identified all clinical trials that used the CFS in the ICU (PubMed searched until 24th June 2020). All patients who were electively admitted were excluded. The primary outcome was ICU mortality. Regression models were estimated on the complete data set, and for missing data, multiple imputations were utilised. Cox models were adjusted for age, sex, and illness acuity score (SOFA, SAPS II or APACHE II). Results 12 studies from 30 countries with anonymised individualised patient data were included (n = 23,989 patients). In the univariate analysis for all patients, being frail (CFS ≥ 5) was associated with an increased risk of ICU mortality, but not after adjustment. In older patients (≥ 65 years) there was an independent association with ICU mortality both in the complete case analysis (HR 1.34 (95% CI 1.25–1.44), p < 0.0001) and in the multiple imputation analysis (HR 1.35 (95% CI 1.26–1.45), p < 0.0001, adjusted for SOFA). In older patients, being vulnerable (CFS 4) alone did not significantly differ from being frail. After adjustment, a CFS of 4–5, 6, and ≥ 7 was associated with a significantly worse outcome compared to CFS of 1–3. Conclusions Being frail is associated with a significantly increased risk for ICU mortality in older patients, while being vulnerable alone did not significantly differ. New Frailty categories might reflect its “continuum” better and predict ICU outcome more accurately. Trial registration: Open Science Framework (OSF: https://osf.io/8buwk/ ). Graphical Abstract

Dates et versions

hal-04123166 , version 1 (09-06-2023)

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Raphael Romano Bruno, Bernhard Wernly, Sean Bagshaw, Mark van den Boogaard, Jai Darvall, et al.. The Clinical Frailty Scale for mortality prediction of old acutely admitted intensive care patients: a meta-analysis of individual patient-level data. Annals of Intensive Care, 2023, 13 (1), pp.37. ⟨10.1186/s13613-023-01132-x⟩. ⟨hal-04123166⟩
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