The following is a summary of “Long-stay ICU patients with frailty: mortality and recovery outcomes at 6 months,” published in the February 2024 issue of Critical Care by Wozniak et al.

Understanding how frail individuals fare during extended ICU stays remains unclear despite the known link between prolonged ICU stays and long-term impairments.

Researchers started a retrospective study to examine the impact of baseline frailty on mortality and post-ICU disability in long-stay ICU patients 6 months after critical illness.

They evaluated patients who spent ≥7 days in ICU (May 2018–May 2021), followed by patient outcomes for up to 6 months or death. The clinical Frailty Scale (CFS) was used to classify into frail (CFS ≥ 5), pre-frail (CFS 3–4), and non-frail (CFS 1–2). Kaplan–Meier curves and a multivariate Cox model were employed to analyze their relationship with mortality. Six-month follow-ups examined psychological, physical, and cognitive outcomes and QoL via descriptive stats and linear regression.

The results showed 531 patients enrolled, 178 (33.6%) were frail, 200 (37.6%) were pre-frail, and 153 (28.8%) were non-frail. Frail patients, being older and having more comorbidities, displayed greater disease severity at ICU admission. Frail patients exhibited a higher mortality rate at 6 months compared to pre-frail and non-frail patients (34.3% (61/178) vs 21% (42/200) vs 13.1% (20/153) respectively, P<0.01)—no significant difference in the rate of withdrawing or withholding of care between the groups. Adjusted HRs of death at 6 months were 1.7 (95% CI 0.9–2.9) for CFS 3–4 and 2.9 (95% CI 1.7–4.9) for CFS ≥ 5 compared to CFS 1–2. At 6 months, 192 patients attended a follow-up consultation. In multivariate linear regressions, CFS ≥ 5 was linked to poorer physical health-related QoL but not poorer mental health-related QoL compared to CFS 1–2.

Investigators concluded that frailty in long-stay ICU patients was linked to higher mortality and poorer physical health-related QoL at 6 months, with the admission of CFS aiding in understanding survivorship complexities during prolonged ICU stays.

Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01261-x