Analysis of frailty as a prognostic factor independent of age: A prospective observational study

Analyze the effects of frailty and prefrailty in patients admitted to the ICU without age limits and to determine the factors associated with mortality. Prospective cohort. Intensive Care Unit, Spain. 1462 critically ill patients without age limits. None. Hospital mortality and health outcomes. Patients’ ages ranged from 15 to 93 years, median of 66 years. Predisposing factors independently associated with frailty and prefrailty were age older than 65 years, female sex, respiratory and renal comorbidities, longer pre-ICU stays, and weekend admission. There is a greater use of noninvasive mechanical ventilation, greater colonization by multidrug-resistant bacteria, and the development of delirium . The risk of hospital mortality was RR 4.04 (2.11–7.74; P < .001) for prefail and 5.88 (2.45–14.10; P < .001) for frail. Factors associated with in-hospital mortality in prefrail and frail were pre-ICU hospital length of stay (cutpoint 4.5 days [1.6–7.4]), greater severity on admission (SAPS3) (cutpoint 64.5 [63.6–65.4]), Glasgow Coma Scale deterioration (OR 4.14 [1.23–13.98]; P .022) and thrombocytopenia (OR 11.46 [2.21–59.42]; P .004). Lower levels of frailty are most common in ICU patients and are associated with worse health outcomes. Our data suggest that frailty and pre frailty should be determined in all patients admitted to the ICU, regardless of their age. Analisis del impacto de la fragilidad y prefragilidad en pacientes ​​críticos sin límite de edad y factores de mortalidad hospitalaria. Cohorte prospectivo. Unidad de Cuidados Intensivos, España. Pacientes críticos sin límite de edad. Ninguna. Mortalidad hospitalaria y resultados de salud. El rango de edad fue 15 a 93 años, mediana 66. Los factores asociados con la fragilidad y prefragilidad fueron ser mayor de 65 años, mujer, comorbilidades respiratorias y renales, estancia previa a UCI, ingreso en fin de semana. Existe un mayor riesgo de ventilación mecánica no invasiva, colonización por bacterias multirresistentes, delirium y mortalidad hospitalaria RR 4.04 (2.11–7.74; P < .001) prefrágiles y 5.88 (2.45–14.10; P < .001) en frágiles. Los factores asociados con la mortalidad hospitalaria (prefrágiles y frágiles) fueron los días de estancia previa a UCI (corte 4.5 [1.6–7.4]), mayor gravedad al ingreso (SAPS3) (corte 64.5 [63.6–65.4]), deterioro Escala Glasgow (OR 4.14 [1.23–13.98]; P .022) y trombocitopenia (OR 11.46 [2.21–59.42]; P .004). Niveles más bajos de fragilidad son frecuentes en UCI y se asocian a peores resultados de salud. Estos resultados apoyan la identificación de la fragilidad ​​y pre fragilidad en todos los pacientes ingresados en UCI independientemente de la edad.