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  • Guidet, BertrandSorbonne Univ, France (författare)

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

  • Artikel/kapitelEngelska2020

Förlag, utgivningsår, omfång ...

  • 2019-11-29
  • Springer-Verlag New York,2020
  • printrdacarrier

Nummerbeteckningar

  • LIBRIS-ID:oai:DiVA.org:umu-171301
  • https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-171301URI
  • https://doi.org/10.1007/s00134-019-05853-1DOI
  • https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-162744URI

Kompletterande språkuppgifter

  • Språk:engelska
  • Sammanfattning på:engelska

Ingår i deldatabas

Klassifikation

  • Ämneskategori:ref swepub-contenttype
  • Ämneskategori:art swepub-publicationtype

Anmärkningar

  • Funding Agencies|Western Health region in Norway; dep. of Epidemiology, University of Aarhus, Denmark
  • PURPOSE: 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.

Ämnesord och genrebeteckningar

Biuppslag (personer, institutioner, konferenser, titlar ...)

  • de Lange, Dylan WUniv Utrecht, Netherlands (författare)
  • Boumendil, ArianeHop St Antoine, France (författare)
  • Leaver, SusannahRes Lead Crit Care Directorate St Georges Hosp, England (författare)
  • Watson, XimenaSt Georges Univ Hosp, England (författare)
  • Boulanger, CarolRoyal Devon and Exeter NHS Fdn Trust, England (författare)
  • Szczeklik, WojciechJagiellonian Univ, Poland (författare)
  • Artigas, AntonioAutonomous Univ Barcelona, Spain (författare)
  • Morandi, AlessandroHosp Ancelle Cremona Italy, Italy (författare)
  • Andersen, FinnAlesund Hosp, Norway (författare)
  • Zafeiridis, TilemachosGen Hosp Larissa Tsakal Larissa, Greece (författare)
  • Jung, ChristianHeinrich Heine Univ, Germany (författare)
  • Moreno, RuiCtr Hosp Univ Lisboa Cent, Portugal (författare)
  • Walther, Sten M.,1954-Linköpings universitet,Avdelningen för diagnostik och specialistmedicin,Medicinska fakulteten,Region Östergötland, Thorax-kärlkliniken i Östergötland(Swepub:liu)stewa50 (författare)
  • Oeyen, SandraUniv Ghent, Belgium (författare)
  • Schefold, Joerg CUniv Bern, Switzerland (författare)
  • Cecconi, MaurizioHumanitas Clin and Res Ctr IRCCS, Italy; Humanitas Univ, Italy (författare)
  • Marsh, BrianMater Misericordiae Univ Hosp, Ireland (författare)
  • Joannidis, MichaelMed Univ Innsbruck, Austria (författare)
  • Nalapko, YuriyEuropean Wellness Int, Ukraine (författare)
  • Elhadi, MuhammedAlkhums Hosp, Libya (författare)
  • Fjølner, JesperAarhus Univ Hosp, Denmark (författare)
  • Flaatten, HansUniv Bergen, Norway; Haukeland Hosp, Norway (författare)
  • Brorsson, CamillaUmeå universitet,Anestesiologi och intensivvård(Swepub:umu)brca0001 (bidragsgivare)
  • Sorbonne Univ, FranceUniv Utrecht, Netherlands (creator_code:org_t)

Sammanhörande titlar

  • Ingår i:Intensive Care Medicine: Springer-Verlag New York46:1, s. 57-690342-46421432-1238

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