The following is a summary of “Frailty’s influence on 30-day mortality in old critically ill ICU patients: a bayesian analysis evaluating the clinical frailty scale,” published in the December 2023 issue of Critical Care by Wernly et al.

Frailty’s impact on ICU outcomes in older patients, traditionally analyzed via frequentist methods, is explored here using a Bayesian approach.

Researchers conducted a retrospective study to investigate the complex interplay between frailty and ICU mortality in older patients using Bayesian statistics, seeking to illuminate the hidden facets of this vital relationship.

They analyzed 10,363 older patients (median age 82 years) from 3 international studies, with 30-day all-cause mortality as the primary outcome. Frailty, defined as Clinical Frailty Scale ≥ 5, was assessed using a hierarchical Bayesian logistic regression model. Covariables were adjusted for using various priors. An international steering committee of registry members achieved consensus on a minimal clinically important difference (MCID).

The results showed a 30-day mortality of 43%, with rates of 38% in non-frail and 51% in frail groups. Post-adjustment, the median OR for frailty was 1.60 (95% CI 1.45–1.76). Frailty was consistently associated with adverse outcomes (OR > 1) with 100% probability and had a 90% chance of exceeding the minimal clinically significant difference (MCID) (OR > 1.5). For the Clinical Frailty Scale (CFS) as a continuous variable, the median OR was 1.19 (1.16–1.22), with over 99% probability of the effect being more significant than 1.5 times the MCID. Frailty remained outside the region of practical equivalence (ROPE) in all analyses, emphasizing its clinical importance regardless of measurement.

They concluded that ICU deaths in frail elderly patients soared with growing frailty scores, urging personalized care beyond simple thresholds.

Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-023-01223-9