The impact of frailty on intensive care unit outcomes: a systematic review and meta-analysis
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Open Access
- 4 July 2017
- journal article
- research article
- Published by Springer Science and Business Media LLC in Intensive Care Medicine
- Vol. 43 (8), 1105-1122
- https://doi.org/10.1007/s00134-017-4867-0
Abstract
Purpose Functional status and chronic health status are important baseline characteristics of critically ill patients. The assessment of frailty on admission to the intensive care unit (ICU) may provide objective, prognostic information on baseline health. To determine the impact of frailty on the outcome of critically ill patients, we performed a systematic review and meta-analysis comparing clinical outcomes in frail and non-frail patients admitted to ICU. Methods We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PubMed, CINAHL, and Clinicaltrials.gov. All study designs with the exception of narrative reviews, case reports, and editorials were included. Included studies assessed frailty in patients greater than 18 years of age admitted to an ICU and compared outcomes between fit and frail patients. Two reviewers independently applied eligibility criteria, assessed quality, and extracted data. The primary outcomes were hospital and long-term mortality. We also determined the prevalence of frailty, the impact on other patient-centered outcomes such as discharge disposition, and health service utilization such as length of stay. Results Ten observational studies enrolling a total of 3030 patients (927 frail and 2103 fit patients) were included. The overall quality of studies was moderate. Frailty was associated with higher hospital mortality [relative risk (RR) 1.71; 95% CI 1.43, 2.05; p < 0.00001; I 2 = 32%] and long-term mortality (RR 1.53; 95% CI 1.40, 1.68; p < 0.00001; I 2 = 0%). The pooled prevalence of frailty was 30% (95% CI 29–32%). Frail patients were less likely to be discharged home than fit patients (RR 0.59; 95% CI 0.49, 0.71; p < 0.00001; I 2 = 12%). Conclusions Frailty is common in patients admitted to ICU and is associated with worsened outcomes. Identification of this previously unrecognized and vulnerable ICU population should act as the impetus for investigating and implementing appropriate care plans for critically ill frail patients. Registration: PROSPERO (ID: CRD42016053910).This publication has 47 references indexed in Scilit:
- The challenge of admitting the very elderly to intensive careAnnals of Intensive Care, 2011
- The Frailty Syndrome: Definition and Natural HistoryClinics in Geriatric Medicine, 2011
- Frailty in the critically ill: a novel conceptCritical Care, 2011
- Outcome instruments to measure frailty: A systematic reviewAgeing Research Reviews, 2011
- Development of a Frailty Index for Patients with Coronary Artery DiseaseJournal of the American Geriatrics Society, 2010
- Redefining Geriatric Preoperative Assessment Using Frailty, Disability and Co-MorbidityAnnals of Surgery, 2009
- Frailty is associated with postoperative complications in older adults with medical problemsArchives of Gerontology and Geriatrics, 2009
- A global clinical measure of fitness and frailty in elderly peopleCMAJ : Canadian Medical Association Journal, 2005
- Quantifying heterogeneity in a meta-analysisStatistics in Medicine, 2002
- Accumulation of Deficits as a Proxy Measure of AgingThe Scientific World Journal, 2001