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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 Study

2019-01Journal article Open access
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dc.contributor.authorGuidet, B
dc.contributor.authorde Lange, D
dc.contributor.authorBoumendil, A
dc.contributor.authorLeaver, S
dc.contributor.authorWatson, X
dc.contributor.authorBoulanger, C
dc.contributor.authorSzczeklik, W
dc.contributor.authorArtigas, A
dc.contributor.authorMorandi, A
dc.contributor.authorAndersen, F
dc.contributor.authorZafeiridis, T
dc.contributor.authorJung, C
dc.contributor.authorMoreno, R
dc.contributor.authorWalther, S
dc.contributor.authorOeyen, S
dc.contributor.authorSchefold, J
dc.contributor.authorCecconi, M
dc.contributor.authorMarsh, B
dc.contributor.authorJoannidis, M
dc.contributor.authorNalapko, Y
dc.contributor.authorElhadi, M
dc.contributor.authorFjølner, J
dc.contributor.authorFlaatten, H
dc.date.accessioned2024-05-22T15:15:35Z
dc.date.available2024-05-22T15:15:35Z
dc.date.issued2019-01
dc.description.abstractPurpose: 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.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationIntensive Care Med . 2020 Jan;46(1):57-69.pt_PT
dc.identifier.doi10.1007/s00134-019-05853-1pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/4918
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherSpringerpt_PT
dc.subjectHSJ UCIpt_PT
dc.subjectHumanspt_PT
dc.subjectFemalept_PT
dc.subjectMalept_PT
dc.subjectActivities of Daily Living / classification*pt_PT
dc.subjectEuropept_PT
dc.subjectAged, 80 and overpt_PT
dc.subjectCognition / physiologypt_PT
dc.subjectComorbidity / trends*pt_PT
dc.subjectFrailty / complicationspt_PT
dc.subjectFrailty / psychologypt_PT
dc.subjectHospitalization / statistics & numerical datapt_PT
dc.subjectIntensive Care Units / organization & administrationpt_PT
dc.subjectIntensive Care Units / standards*pt_PT
dc.subjectIntensive Care Units / statistics & numerical datapt_PT
dc.subjectKaplan-Meier Estimatept_PT
dc.subjectMultivariate Analysispt_PT
dc.subjectOutcome Assessment, Health Care / statistics & numerical data*pt_PT
dc.subjectPrevalencept_PT
dc.subjectProportional Hazards Modelspt_PT
dc.subjectProspective Studiespt_PT
dc.titleThe Contribution of Frailty, Cognition, Activity of Daily Life and Comorbidities on Outcome in Acutely Admitted Patients Over 80 Years in European ICUs: the VIP2 Studypt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage69pt_PT
oaire.citation.issue1pt_PT
oaire.citation.startPage57pt_PT
oaire.citation.titleIntensive Care Medicinept_PT
oaire.citation.volume46pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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