As patients increasingly survive critical illness, evidence is mounting to show that survivorship is fraught with cognitive problems, disability, and increased mortality risk beyond the ICU but why these problems develop is unclear, says Nathan Brummel, MD, MSCI.
For a study published in the American Journal of Respiratory and Critical Care Medicine, Dr. Brummel and colleagues enrolled ICU patients with respiratory failure or shock. Frailty was measured at ICU admission using the Clinical Frailty Scale. At 3 and 12 months post-discharge, survivors’ cognitive function, basic and instrumental activities of daily living (ADLs), and vital status were assessed.
Although frailty is traditionally thought of as a geriatric syndrome, 50% of study participants who met the definition for clinical frailty were younger than 65. “We also found that frailty predicted greater mortality, greater disability in instrumental ADLs, and worse quality of life as the severity of frailty increased,” says Dr. Brummel, “independent of factors traditionally associated with critical illness, such as baseline functional or cognitive status and how sick patients were in the ICU.”
Frailty scores were not associated with disability in basic ADLs or with cognition. “Inability to perform basic ADLs is also associated with greater mortality, so there’s a competing risk,” Dr. Brummel says. “We didn’t see an association because those patients may have died. As far as why frailty wasn’t associated with cognition, we specifically excluded people who had dementia prior to ICU admission.” He adds that studies showing such an association had much longer follow-up periods.
“The study shows we’re able to use a simple scale at ICU admission to identify patients who are at increased risk of poor outcomes,” concludes Dr. Brummel.
Brummel N, Bell S, Girard T, et al. Frailty and Subsequent Disability and Mortality among Patients With Critical Illness. Am J Respir Crit Care Med. 2017;196(1):64-72. Available at www.atsjournals.org/doi/abs/10.1164/rccm.201605-0939OC.