1Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine2Center for Health Services Research3Center for Quality Aging4Division of Cardiovascular Medicine5Vanderbilt Memory & Alzheimer's Center7Division of Critical Care, Department of Anesthesiology8Department of Psychiatry and Behavioral Sciences, and12Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee6Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania9Research Service and13Geriatric Research, Education and Clinical Center Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee10Geriatric Research Group, Brescia, Italy11Department of Rehabilitation and Aged Care, Hospital Ancelle, Cremona, Italy; and14Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
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Rationale:The prevalence of frailty (diminished physiologic reserve) and its effect on outcomes for those aged 18 years and older with critical illness is unclear.Objectives:We hypothesized greater frailty would be associated with subsequent mortality, disability, and cognitive impairment, regardless of age.Methods:At enrollment, we measured frailty using the Clinical Frailty Scale (range, 1 [very fit] to 7 [severely frail]). At 3 and 12 months post-discharge, we assessed vital status, instrumental activities of daily living, basic activities of daily living, and cognition. We used multivariable regression to analyze associations between Clinical Frailty Scale scores and outcomes, adjusting for age, sex, education, comorbidities, baseline disability, baseline cognition, severity of illness, delirium, coma, sepsis, mechanical ventilation, and sedatives/opiates.Measurements and Main Results:We enrolled 1,040 patients who were a median (interquartile range) of 62 (53-72) years old and who had a median Clinical Frailty Scale score of 3 (3-5). Half of those with clinical frailty (i.e., Clinical Frailty Scale score ≥5) were younger than 65 years old. Greater Clinical Frailty Scale scores were independently associated with greater mortality (P = 0.01 at 3 mo and P < 0.001 at 12 mo) and with greater odds of disability in instrumental activities of daily living (P = 0.04 at 3 mo and P = 0.002 at 12 mo). Clinical Frailty Scale scores were not associated with disability in basic activities of daily living or with cognition.Conclusions:Frailty is common in critically ill adults aged 18 years and older and is independently associated with increased mortality and greater disability. Future studies should explore routine screening for clinical frailty in critically ill patients of all ages. Interventions to reduce mortality and disability among patients with heightened vulnerability should be developed and tested.Clinical trial registered with www.clinicaltrials.gov (NCT 00392795 and NCT 00400062).