Browsing by Author "Guidet, B"
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- Association of Chronic Heart Failure with Mortality in Old Intensive Care Patients Suffering from Covid‐19Publication . Romano Bruno, R; Wernly, B; Wolff, G; Fjølner, J; Artigas, A; Bollen Pinto, B; Schefold, J; Kindgen‐Milles, D; Baldia, P; Kelm, M; Beil, M; Sviri, S; Heerden, P; Szczeklik, W; Topeli, A; Elhadi, M; Joannidis, M; Oeyen, S; Kondili, E; Marsh, B; Andersen, F; Moreno, R; Leaver, S; Boumendil, A; De Lange, D; Guidet, B; Flaatten, H; Jung, CAims: Chronic heart failure (CHF) is a major risk factor for mortality in coronavirus disease 2019 (COVID-19). This prospective international multicentre study investigates the role of pre-existing CHF on clinical outcomes of critically ill old (≥70 years) intensive care patients with COVID-19. Methods and results: Patients with pre-existing CHF were subclassified as having ischaemic or non-ischaemic cardiac disease; patients with a documented ejection fraction (EF) were subclassified according to heart failure EF: reduced (HFrEF, n = 132), mild (HFmrEF, n = 91), or preserved (HFpEF, n = 103). Associations of heart failure characteristics with the 30 day mortality were analysed in univariate and multivariate logistic regression analyses. Pre-existing CHF was reported in 566 of 3917 patients (14%). Patients with CHF were older, frailer, and had significantly higher SOFA scores on admission. CHF patients showed significantly higher crude 30 day mortality [60% vs. 48%, P < 0.001; odds ratio 1.87, 95% confidence interval (CI) 1.5-2.3] and 3 month mortality (69% vs. 56%, P < 0.001). After multivariate adjustment for confounders (SOFA, age, sex, and frailty), no independent association of CHF with mortality remained [adjusted odds ratio (aOR) 1.2, 95% CI 0.5-1.5; P = 0.137]. More patients suffered from pre-existing ischaemic than from non-ischaemic disease [233 vs. 328 patients (n = 5 unknown aetiology)]. There were no differences in baseline characteristics between ischaemic and non-ischaemic disease or between HFrEF, HFmrEF, and HFpEF. Crude 30 day mortality was significantly higher in HFrEF compared with HFpEF (64% vs. 48%, P = 0.042). EF as a continuous variable was not independently associated with 30 day mortality (aOR 0.98, 95% CI 0.9-1.0; P = 0.128). Conclusions: In critically ill older COVID-19 patients, pre-existing CHF was not independently associated with 30 day mortality.
- Attitudes of Physicians Towards the Care of Critically Ill Elderly Patients - a European SurveyPublication . Guidet, B; De Lange, DW; Christensen, S; Moreno, R; Fjølner, J; Dumas, G; Flaatten, HBackground: Very elderly patients are one of the fastest growing population in ICUs worldwide. There are lots of controversies regarding admission, discharge of critically ill elderly patients, and also on treatment intensity during the ICU stay. As a consequence, practices vary considerably from one ICU to another. In that perspective, we collected opinions of experienced ICU physicians across Europe on statements focusing on patients older than 80. Methods: We sent an online questionnaire to the coordinator ICU physician of all participating ICUs of an recent European, observational study of Very old critically Ill Patients (VIP1 study). This questionnaire contained 12 statements about admission, triage, treatment and discharge of patients older than 80. Results: We received answers from 162 ICUs (52% of VIP1-study) spanning 20 different European countries. There were major disagreements between ICUs. Responders disagree that: there is clear evidence that ICU admission is beneficial (37%); seeking relatives' opinion is mandatory (17%); written triage guidelines must be available either at the hospital or ICU level (20%); level of care should be reduced (25%); a consultation of a geriatrician should be sought (34%) and a geriatrician should be part of the post-ICU trail (11%). The percentage of disagreement varies between statements and European regions. Conclusion: There are major differences in the attitude of European ICU physicians on the admission, triage and treatment policies of patients older than 80 emphasizing the lack of consensus and poor level of evidence for most of the statements and outlining the need for future interventional studies.
- A Comparison of Very Old Patients Admitted to Intensive Care Unit After Acute Versus Elective Surgery or InterventionPublication . Jung, C; Wernly, B; Muessig, J; Kelm, M; Boumendil, A; Morandi, A; Andersen, F; Artigas, A; Bertolini, G; Cecconi, M; Christensen, S; Faraldi, L; Fjølner, J; Lichtenauer, M; Bruno, R; Marsh, B; Moreno, R; Oeyen, S; Öhman, C; Pinto, B; Soliman, I; Szczeklik, W; Valentin, A; Watson, X; Zafeiridis, T; De Lange, D; Guidet, B; Flaatten, H; VIP1 Study GroupBackground: We aimed to evaluate differences in outcome between patients admitted to intensive care unit (ICU) after elective versus acute surgery in a multinational cohort of very old patients (≥80 years; VIP). Predictors of mortality, with special emphasis on frailty, were assessed. Methods: In total, 5063 VIPs were included in this analysis, 922 were admitted after elective surgery or intervention, 4141 acutely, with 402 after acute surgery. Differences were calculated using Mann-Whitney-U test and Wilcoxon test. Univariate and multivariable logistic regression were used to assess associations with mortality. Results: Compared patients admitted after acute surgery, patients admitted after elective surgery suffered less often from frailty as defined as CFS (28% vs 46%; p < 0.001), evidenced lower SOFA scores (4 ± 5 vs 7 ± 7; p < 0.001). Presence of frailty (CFS >4) was associated with significantly increased mortality both in elective surgery patients (7% vs 12%; p = 0.01), in acute surgery (7% vs 12%; p = 0.02). Conclusions: VIPs admitted to ICU after elective surgery evidenced favorable outcome over patients after acute surgery even after correction for relevant confounders. Frailty might be used to guide clinicians in risk stratification in both patients admitted after elective and acute surgery. Trial registration: NCT03134807. Registered 1st May 2017.
- Increased 30-Day Mortality in Very Old ICU Patients with COVID-19 Compared to Patients with Respiratory Failure without COVID-19Publication . Guidet, B; Jung, C; Flaatten, H; Fjølner, J; Artigas, A; Bollen Pinto, B; Schefold, J; Beil, M; Sigal, S; Vernon van Heerden, P; Szczeklik, W; Joannidis, M; Oeyen, S; Kondili, E; Marsh, B; Andersen, F; Moreno, R; Cecconi, M; Leaver, S; De Lange, D; Boumendil, A; Eller, P; Joannidis, M; Mesotten, D; Reper, P; Oeyen, S; Swinnen, W; Brix, H; Brushoej, J; Villefrance, M; Nedergaard, H; Bjerregaard, A; Balleby, I; Andersen, K; Hansen, M; Uhrenholt, S; Bundgaard, H; Fjølner, J; Hussein, A; Salah, R; Ali, Y; Wassim, K; Elgazzar, Y; Tharwat, S; Azzam, A; Habib, A; Abosheaishaa, H; Azab, M; Leaver, S; Galbois, A; Urbina, T; Charron, C; Guerot, E; Besch, G; Rigaud, JP; Maizel, J; Djibré, M; Burtin, P; Garcon, P; Nseir, S; Valette, X; Alexandru, N; Marin, N; Vaissiere, M; Plantefeve, G; Vanderlinden, T; Jurcisin, I; Megarbane, B; Caillard, A; Valent, A; Garnier, M; Besset, S; Oziel, J; Raphalen, J; Dauger, S; Dumas, G; Goncalves, B; Piton, G; Barth, E; Goebel, U; Barth, E; Kunstein, A; Schuster, M; Welte, M; Lutz, M; Meybohm, P; Steiner, S; Poerner, T; Haake, H; Schaller, S; Schaller, S; Schaller, S; Kindgen-Milles, D; Meyer, C; Kurt, M; Kuhn, K; Randerath, W; Wollborn, J; Dindane, Z; Kabitz, H; Voigt, I; Shala, G; Faltlhauser, A; Rovina, N; Aidoni, Z; Chrisanthopoulou, E; Papadogoulas, A; Gurjar, M; Mahmoodpoor, A; Ahmed, A; Marsh, B; Elsaka, A; Sviri, S; Comellini, V; Rabha, A; Ahmed, H; Namendys-Silva, S; Ghannam, A; Groenendijk, M; Zegers, M; de Lange, D; Cornet, A; Evers, M; Haas, L; Dormans, T; Dieperink, W; Romundstad, L; Sjøbø, B; Andersen, F; Strietzel, H; Olasveengen, T; Hahn, M; Czuczwar, M; Gawda, R; Klimkiewicz, J; Santos, ML; Gordinho, A; Santos, H; Assis, R; Oliveira, AI; Badawy, M; Perez-Torres, D; Gomà, G; Villamayor, M; Mira, A; Cubero, P; Rivera, S; Tomasa, T; Iglesias, D; Vázquez, E; Aldecoa, C; Ferreira, A; Zalba-Etayo, B; Canas-Perez, I; Tamayo-Lomas, L; Diaz-Rodriguez, C; Sancho, S; Priego, J; Abualqumboz, E; Hilles, M; Saleh, M; Ben-Hamouda, N; Roberti, A; Dullenkopf, A; Fleury, Y; Pinto, B; Schefold, J; Al-Sadaw, MPurpose: The number of patients ≥ 80 years admitted into critical care is increasing. Coronavirus disease 2019 (COVID-19) added another challenge for clinical decisions for both admission and limitation of life-sustaining treatments (LLST). We aimed to compare the characteristics and mortality of very old critically ill patients with or without COVID-19 with a focus on LLST. Methods: Patients 80 years or older with acute respiratory failure were recruited from the VIP2 and COVIP studies. Baseline patient characteristics, interventions in intensive care unit (ICU) and outcomes (30-day survival) were recorded. COVID patients were matched to non-COVID patients based on the following factors: age (± 2 years), Sequential Organ Failure Assessment (SOFA) score (± 2 points), clinical frailty scale (± 1 point), gender and region on a 1:2 ratio. Specific ICU procedures and LLST were compared between the cohorts by means of cumulative incidence curves taking into account the competing risk of discharge and death. Results: 693 COVID patients were compared to 1393 non-COVID patients. COVID patients were younger, less frail, less severely ill with lower SOFA score, but were treated more often with invasive mechanical ventilation (MV) and had a lower 30-day survival. 404 COVID patients could be matched to 666 non-COVID patients. For COVID patients, withholding and withdrawing of LST were more frequent than for non-COVID and the 30-day survival was almost half compared to non-COVID patients. Conclusion: Very old COVID patients have a different trajectory than non-COVID patients. Whether this finding is due to a decision policy with more active treatment limitation or to an inherent higher risk of death due to COVID-19 is unclear.
- Prognosticating the Outcome of Intensive Care in Older Patients - a Narrative ReviewPublication . Beil, M; Moreno, R; Fronczek, J; Kogan, Y; Moreno, R; Flaatten, H; Guidet, B; de Lange, D; Leaver, S; Nachshon, A; van Heerden, P; Joskowicz, L; Sviri, S; Jung, C; Szczeklik, WPrognosis determines major decisions regarding treatment for critically ill patients. Statistical models have been developed to predict the probability of survival and other outcomes of intensive care. Although they were trained on the characteristics of large patient cohorts, they often do not represent very old patients (age ≥ 80 years) appropriately. Moreover, the heterogeneity within this particular group impairs the utility of statistical predictions for informing decision-making in very old individuals. In addition to these methodological problems, the diversity of cultural attitudes, available resources as well as variations of legal and professional norms limit the generalisability of prediction models, especially in patients with complex multi-morbidity and pre-existing functional impairments. Thus, current approaches to prognosticating outcomes in very old patients are imperfect and can generate substantial uncertainty about optimal trajectories of critical care in the individual. This article presents the state of the art and new approaches to predicting outcomes of intensive care for these patients. Special emphasis has been given to the integration of predictions into the decision-making for individual patients. This requires quantification of prognostic uncertainty and a careful alignment of decisions with the preferences of patients, who might prioritise functional outcomes over survival. Since the performance of outcome predictions for the individual patient may improve over time, time-limited trials in intensive care may be an appropriate way to increase the confidence in decisions about life-sustaining treatment.
- Sepsis at ICU Admission Does Not Decrease 30-Day Survival in Very Old Patients: a Post-Hoc Analysis of the VIP1 Multinational Cohort StudyPublication . Ibarz, M; Boumendil, A; Haas, L; Irazabal, M; Flaatten, H; de Lange, D; Morandi, A; Andersen, F; Bertolini, G; Cecconi, M; Christensen, S; Faraldi, L; Fjølner, J; Jung, C; Marsh, B; Moreno, R; Oeyen, S; Öhman, C; Bollen Pinto, B; Soliman, I; Szczeklik, W; Valentin, A; Watson, X; Zaferidis, T; Guidet, B; Artigas, ABackground: The number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determine whether VIPs admitted for sepsis had different outcomes than those admitted for other acute reasons and identify potential prognostic factors for 30-day survival. Results: This prospective study included VIPs with Sequential Organ Failure Assessment (SOFA) scores ≥ 2 acutely admitted to 307 ICUs in 21 European countries. Of 3869 acutely admitted VIPs, 493 (12.7%) [53.8% male, median age 83 (81-86) years] were admitted for sepsis. Sepsis was defined according to clinical criteria; suspected or demonstrated focus of infection and SOFA score ≥ 2 points. Compared to VIPs admitted for other acute reasons, VIPs admitted for sepsis were younger, had a higher SOFA score (9 vs. 7, p < 0.0001), required more vasoactive drugs [82.2% vs. 55.1%, p < 0.0001] and renal replacement therapies [17.4% vs. 9.9%; p < 0.0001], and had more life-sustaining treatment limitations [37.3% vs. 32.1%; p = 0.02]. Frailty was similar in both groups. Unadjusted 30-day survival was not significantly different between the two groups. After adjustment for age, gender, frailty, and SOFA score, sepsis had no impact on 30-day survival [HR 0.99 (95% CI 0.86-1.15), p = 0.917]. Inverse-probability weight (IPW)-adjusted survival curves for the first 30 days after ICU admission were similar for acute septic and non-septic patients [HR: 1.00 (95% CI 0.87-1.17), p = 0.95]. A matched-pair analysis in which patients with sepsis were matched with two control patients of the same gender with the same age, SOFA score, and level of frailty was also performed. A Cox proportional hazard regression model stratified on the matched pairs showed that 30-day survival was similar in both groups [57.2% (95% CI 52.7-60.7) vs. 57.1% (95% CI 53.7-60.1), p = 0.85]. Conclusions: After adjusting for organ dysfunction, sepsis at admission was not independently associated with decreased 30-day survival in this multinational study of 3869 VIPs. Age, frailty, and SOFA score were independently associated with survival.
- Sex-Specific Outcome Disparities in Very Old Patients Admitted to Intensive Care Medicine: a Propensity Matched AnalysisPublication . Wernly, B; Romano Bruno, R; Kelm, M; Boumendil, A; Morandi, A; Andersen, F; Artigas, A; Finazzi, S; Cecconi, M; Christensen, S; Faraldi, L; Lichtenauer, M; Muessig, J; Marsh, B; Moreno, R; Oeyen, S; Öhman, C; Bollen Pinto, B; Soliman, I; Szczeklik, W; Niederseer, D; Valentin, A; Watson, X; Leaver, S; Boulanger, C; Walther, S; Schefold, J; Joannidis, M; Nalapko, Y; Elhadi, M; Fjølner, J; Zafeiridis, T; De Lange, D; Guidet, B; Flaatten, H; Jung, CFemale and male very elderly intensive patients (VIPs) might differ in characteristics and outcomes. We aimed to compare female versus male VIPs in a large, multinational collective of VIPs with regards to outcome and predictors of mortality. In total, 7555 patients were included in this analysis, 3973 (53%) male and 3582 (47%) female patients. The primary endpoint was 30-day-mortality. Baseline characteristics, data on management and geriatric scores including frailty assessed by Clinical Frailty Scale (CFS) were documented. Two propensity scores (for being male) were obtained for consecutive matching, score 1 for baseline characteristics and score 2 for baseline characteristics and ICU management. Male VIPs were younger (83 ± 5 vs. 84 ± 5; p < 0.001), less often frail (CFS > 4; 38% versus 49%; p < 0.001) but evidenced higher SOFA (7 ± 6 versus 6 ± 6 points; p < 0.001) scores. After propensity score matching, no differences in baseline characteristics could be observed. In the paired analysis, the mortality in male VIPs was higher (mean difference 3.34% 95%CI 0.92-5.76%; p = 0.007) compared to females. In both multivariable logistic regression models correcting for propensity score 1 (aOR 1.15 95%CI 1.03-1.27; p = 0.007) and propensity score 2 (aOR 1.15 95%CI 1.04-1.27; p = 0.007) male sex was independently associated with higher odds for 30-day-mortality. Of note, male gender was not associated with ICU mortality (OR 1.08 95%CI 0.98-1.19; p = 0.14). Outcomes of elderly intensive care patients evidenced independent sex differences. Male sex was associated with adverse 30-day-mortality but not ICU-mortality. Further research to identify potential sex-specific risk factors after ICU discharge is warranted.Trial registration: NCT03134807 and NCT03370692; Registered on May 1, 2017 https://clinicaltrials.gov/ct2/show/NCT03370692 .
- The Contribution of Frailty, Cognition, Activity of Daily Life and Comorbidities on Outcome in Acutely Admitted Patients Over 80 Years in European ICUs: the VIP2 StudyPublication . Guidet, B; de Lange, D; Boumendil, A; Leaver, S; Watson, X; Boulanger, C; Szczeklik, W; Artigas, A; Morandi, A; Andersen, F; Zafeiridis, T; Jung, C; Moreno, R; Walther, S; Oeyen, S; Schefold, J; Cecconi, M; Marsh, B; Joannidis, M; Nalapko, Y; Elhadi, M; Fjølner, J; Flaatten, HPurpose: Premorbid conditions affect prognosis of acutely-ill aged patients. Several lines of evidence suggest geriatric syndromes need to be assessed but little is known on their relative effect on the 30-day survival after ICU admission. The primary aim of this study was to describe the prevalence of frailty, cognition decline and activity of daily life in addition to the presence of comorbidity and polypharmacy and to assess their influence on 30-day survival. Methods: Prospective cohort study with 242 ICUs from 22 countries. Patients 80 years or above acutely admitted over a six months period to an ICU between May 2018 and May 2019 were included. In addition to common patients' characteristics and disease severity, we collected information on specific geriatric syndromes as potential predictive factors for 30-day survival, frailty (Clinical Frailty scale) with a CFS > 4 defining frail patients, cognitive impairment (informant questionnaire on cognitive decline in the elderly (IQCODE) with IQCODE ≥ 3.5 defining cognitive decline, and disability (measured the activity of daily life with the Katz index) with ADL ≤ 4 defining disability. A Principal Component Analysis to identify co-linearity between geriatric syndromes was performed and from this a multivariable model was built with all geriatric information or only one: CFS, IQCODE or ADL. Akaike's information criterion across imputations was used to evaluate the goodness of fit of our models. Results: We included 3920 patients with a median age of 84 years (IQR: 81-87), 53.3% males). 80% received at least one organ support. The median ICU length of stay was 3.88 days (IQR: 1.83-8). The ICU and 30-day survival were 72.5% and 61.2% respectively. The geriatric conditions were median (IQR): CFS: 4 (3-6); IQCODE: 3.19 (3-3.69); ADL: 6 (4-6); Comorbidity and Polypharmacy score (CPS): 10 (7-14). CFS, ADL and IQCODE were closely correlated. The multivariable analysis identified predictors of 1-month mortality (HR; 95% CI): Age (per 1 year increase): 1.02 (1.-1.03, p = 0.01), ICU admission diagnosis, sequential organ failure assessment score (SOFA) (per point): 1.15 (1.14-1.17, p < 0.0001) and CFS (per point): 1.1 (1.05-1.15, p < 0.001). CFS remained an independent factor after inclusion of life-sustaining treatment limitation in the model. Conclusion: We confirm that frailty assessment using the CFS is able to predict short-term mortality in elderly patients admitted to ICU. Other geriatric syndromes do not add improvement to the prediction model. Since CFS is easy to measure, it should be routinely collected for all elderly ICU patients in particular in connection to advance care plans, and should be used in decision making.
- The Contribution of Frailty, Cognition, Activity of Daily Life and Comorbidities on Outcome in Acutely Admitted Patients Over 80 Years in European ICUs: the VIP2 StudyPublication . Guidet, B; de Lange, DW; Boumendil, A; Leaver, S; Watson, X; Boulanger, C; Szczeklik, W; Artigas, A; Morandi, A; Andersen, F; Zafeiridis, T; Jung, C; Moreno, R; Walther, S; Oeyen, S; Schefold, JC; Cecconi, M; Marsh, B; Joannidis, M; Nalapko, Y; Elhadi, M; Fjølner, J; Flaatten, HPurpose: Premorbid conditions affect prognosis of acutely-ill aged patients. Several lines of evidence suggest geriatric syndromes need to be assessed but little is known on their relative effect on the 30-day survival after ICU admission. The primary aim of this study was to describe the prevalence of frailty, cognition decline and activity of daily life in addition to the presence of comorbidity and polypharmacy and to assess their influence on 30-day survival. Methods: Prospective cohort study with 242 ICUs from 22 countries. Patients 80 years or above acutely admitted over a six months period to an ICU between May 2018 and May 2019 were included. In addition to common patients' characteristics and disease severity, we collected information on specific geriatric syndromes as potential predictive factors for 30-day survival, frailty (Clinical Frailty scale) with a CFS > 4 defining frail patients, cognitive impairment (informant questionnaire on cognitive decline in the elderly (IQCODE) with IQCODE ≥ 3.5 defining cognitive decline, and disability (measured the activity of daily life with the Katz index) with ADL ≤ 4 defining disability. A Principal Component Analysis to identify co-linearity between geriatric syndromes was performed and from this a multivariable model was built with all geriatric information or only one: CFS, IQCODE or ADL. Akaike's information criterion across imputations was used to evaluate the goodness of fit of our models. Results: We included 3920 patients with a median age of 84 years (IQR: 81-87), 53.3% males). 80% received at least one organ support. The median ICU length of stay was 3.88 days (IQR: 1.83-8). The ICU and 30-day survival were 72.5% and 61.2% respectively. The geriatric conditions were median (IQR): CFS: 4 (3-6); IQCODE: 3.19 (3-3.69); ADL: 6 (4-6); Comorbidity and Polypharmacy score (CPS): 10 (7-14). CFS, ADL and IQCODE were closely correlated. The multivariable analysis identified predictors of 1-month mortality (HR; 95% CI): Age (per 1 year increase): 1.02 (1.-1.03, p = 0.01), ICU admission diagnosis, sequential organ failure assessment score (SOFA) (per point): 1.15 (1.14-1.17, p < 0.0001) and CFS (per point): 1.1 (1.05-1.15, p < 0.001). CFS remained an independent factor after inclusion of life-sustaining treatment limitation in the model. Conclusion: We confirm that frailty assessment using the CFS is able to predict short-term mortality in elderly patients admitted to ICU. Other geriatric syndromes do not add improvement to the prediction model. Since CFS is easy to measure, it should be routinely collected for all elderly ICU patients in particular in connection to advance care plans, and should be used in decision making.
- The Impact of Frailty on ICU and 30-Day Mortality and the Level of Care in Very Elderly Patients (≥ 80 Years)Publication . Flaatten, H; De Lange, DW; Morandi, A; Andersen, FH; Artigas, A; Bertolini, G; Boumendil, A; Cecconi, M; Christensen, S; Faraldi, L; Fjølner, J; Jung, C; Marsh, B; Moreno, R; Oeyen, S; Öhman, C; Pinto, B; Soliman, I; Szczeklik, W; Valentin, A; Watson, X; Zaferidis, T; Guidet, BPURPOSE: Very old critical ill patients are a rapid expanding group in the ICU. Indications for admission, triage criteria and level of care are frequently discussed for such patients. However, most relevant outcome studies in this group frequently find an increased mortality and a reduced quality of life in survivors. The main objective was to study the impact of frailty compared with other variables with regards to short-term outcome in the very old ICU population. METHODS: A transnational prospective cohort study from October 2016 to May 2017 with 30 days follow-up was set up by the European Society of Intensive Care Medicine. In total 311 ICUs from 21 European countries participated. The ICUs included the first consecutive 20 very old (≥ 80 years) patients admitted to the ICU within a 3-month inclusion period. Frailty, SOFA score and therapeutic procedures were registered, in addition to limitations of care. For measurement of frailty the Clinical Frailty Scale was used at ICU admission. The main outcomes were ICU and 30-day mortality and survival at 30 days. RESULTS: A total of 5021 patients with a median age of 84 years (IQR 81-86 years) were included in the final analysis, 2404 (47.9%) were women. Admission was classified as acute in 4215 (83.9%) of the patients. Overall ICU and 30-day mortality rates were 22.1% and 32.6%. During ICU stay 23.8% of the patients did not receive specific ICU procedures: ventilation, vasoactive drugs or renal replacement therapy. Frailty (values ≥ 5) was found in 43.1% and was independently related to 30-day survival (HR 1.54; 95% CI 1.38-1.73) for frail versus non-frail. CONCLUSIONS: Among very old patients (≥ 80 years) admitted to the ICU, the consecutive classes in Clinical Frailty Scale were inversely associated with short-term survival. The scale had a very low number of missing data. These findings provide support to add frailty to the clinical assessment in this patient group.