A Prospective Study Evaluating Association between Frailty and Mortality in Critically Ill Elderly Population

INTRODUCTION: The study addresses the increasing elderly population worldwide, focusing on frailty as a critical factor influencing their outcomes in Intensive Care Unit (ICU). Frailty, defined as reduced physiological reserve and heightened vulnerability to illness, was assessed using the Clinical Frailty Scale (CFS). OBJECTIVES: Primary objective of the study was to determine whether frailty in elderly patients was associated with higher mortality rates during hospital stay, at 30 days and 90 days of admission during a critical illness. Secondary objectives included determination of effects of frailty on organ support requirements like mechanical ventilation, vasopressor support and renal replacement therapy. It also aimed to assess whether frailty was associated with increased resource utilization (length of ICU and hospital stay). MATERIALS AND METHODS: This prospective observational study was conducted at a tertiary care hospital in South Kerala over a period of 1 year (June 2022–May 2023). Patients aged 60 years and above admitted to the medical ICU were included, while those with survival expectancy under 24 hours of admission or discharged against medical advice were excluded. Frailty was determined using the CFS (score >4) developed by Canadian study of Health and Ageing. APACHE II and SOFA scores were used to assess disease severity among frail and non-frail patients for proper comparison. Key outcomes measured included all-cause in-hospital mortality, mortality at 30 and 90 days, duration of ICU and hospital stay, complications, and resource utilization. The study employed statistical analyses such as Kaplan-Meier survival analysis, Pearson Chi-square test, Fishers exact tests, and SPSS statistical software to evaluate results. RESULTS: 154 patients were analysed and 68.2% were found to be frail. Frail patients were found to have higher mean age (77.38 vs. 69.43 years) and female gender had higher frailty prevalence compared to men (80% vs 58.33%). Frail patients had higher APACHE II scores (p value-0.014) but required similar levels of mechanical ventilation, renal therapy, and vasopressors as non-frail patients. In-hospital mortality rates (24.8 vs 28.6%), 30-day (21 vs 28.6%) and 90-day mortality rates (37.1 vs 32.7%) did not have statistically significant difference between frail and non-frail subjects. Frailty was found not to be associated with increased ICU resource (mechanical ventilation, renal replacement therapy etc..) and health service utilisation (ICU and hospital length of stay, p values- 0.999 & 0.344 respectively). DISCUSSIONS/CONCLUSIONS: Prevalence of frailty was found to be high (68.2%) and associated with advancing age, female gender and increase in number of comorbidities. Frail elderly population had higher APACHE II scores but had similar ICU and hospital resource utilisation. The study found that frailty was not associated with in-hospital and short term (30 and 90 days) mortality rates and, also in their need for specific organ support therapies. The findings underscore the importance of frailty assessment in ICU settings to optimize resource allocation and care strategies.